Background: Unfractionated heparin (UFH), despite its limitations, has been used as the primary anticoagulant alternative during the percutaneous coronary intervention (PCI). Some studies indicated that intravenous enoxaparin could be an effective and safe option. Our team used enoxaparin alone at one time according to the guidelines (Class IIA) and found a little catheter thrombosis during PCI. We recommend a new anticoagulation strategy using enoxaparin in combination with UFH. Enoxaparin has a more predictable anticoagulant response with no need of repeatedly monitoring anticoagulation during PCI. This retrospective study aimed to evaluate the efficacy and safety of using enoxaparin in combination with UFH in PCI patients with complex coronary artery disease.
Methods: Between January 2015 and April 2017, 600 PCI patients who received intravenous UFH at an initial dose of 3000 U plus intravenous enoxaparin at a dose of 0.75 mg/kg (observation group) and 600 PCI patients who received UFH at a dose of 100 U/kg (control group) were consecutively included in this retrospective study. The endpoints were postoperative 48-h thrombolysis in myocardial infarction (TIMI) bleeding and transfusion and 30-day and 1-year major adverse cardio-cerebrovascular events (MACCE).
Results: Baseline clinical, angiographic, and procedural characteristics were similar between groups, except there was less stent implantation per patient in the observation group (2.13 vs. 2.25 in the control group, P = 0.002). TIMI bleeding (3.3% vs. 4.7%) showed no significant difference between the observation group and control group. During the 30-day follow-up, the rate of MACCE was 0.9% in the observation group and 1.5% in the control group. There was no significant difference in the rates of MACCE, death, myocardial infarction, target vessel revascularization, cerebrovascular event, and angina within 30 days and 1 year after PCI between groups as well as in the subgroup analysis of transfemoral approach.
Conclusions: UFH with sequential enoxaparin has similar anticoagulant effect and safety as UFH in PCI of complex coronary artery disease.
“普通肝素-依诺肝素”序贯抗凝在复杂冠脉的介入治疗中的应用 摘要 背景：尽管普通肝素有一些缺点，目前仍然作为介入手术过程中最主要的抗凝剂。研究发现依诺肝素（低分子肝素）也是一种安全而且有效的选择。依据国外指南（Class IIA），我们之前尝试在介入手术中单独应用低分子肝素，但是术中观察到导管内血栓的形成。鉴于此，我们推荐一种新的术中抗凝策略，即“普通肝素-依诺肝素”序贯抗凝。临床上，介入手术过程中使用低分子肝素会有稳定的抗凝时间，并不需要频繁的抗凝监测。我们这个回顾性研究的目的就是在复杂的冠脉介入手术中，对比普通肝素以及我们的方案的安全性和有效性。 方法：连续性收集来自2015年1月至2017年4月，600例行支架植入并接受我们方案（在3000U普通肝素的基础上按每公斤体重 再给予0.75mg的低分子肝素导管内推注，观察组）的患者，以及另外600例接受普通肝素（按每公斤体重给予100U的普通肝素导管内推注，对照组）的患者。终点事件是术后48小时的TIMI出血、输血和30天以及1年的心脑血管事件的发生。 结果：除了观察组的每个病人的支架植入数量（2.13个）不同于对照组（2.25个，P=0.002），2组的其余基线临床资料基本相似。2组的TIMI出血并没有发现统计学差异(3.3% 对比 4.7%)。在30天的随访中，观察组中的心脑血管事件的发生率是0.9%，在对照组中是1.5%，同样也没有发现2组的差异性。在支架术后的30天以及1年的心脑血管事件的发生率、全因死亡、心梗、血运重建、脑卒中、心绞痛再发以及经股动脉的亚组分析中均没有发现2组之间有差异性。 结论：“普通肝素-依诺肝素”序贯抗凝在复杂冠脉手术中有着与普通肝素相似的抗凝效果以及安全性。.
Keywords: Complex Coronary Heart Disease; Enoxaparin; Percutaneous Coronary Intervention; Unfractionated Heparin.