| 摘要: |
| 目的 探讨经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术后依诺肝素抗凝对不同年龄患者临床事件的影响. 方法 2010年至2014年入选未发生无复流及冠脉夹层等具有血栓高危因素等并发症的PCI术后患者700例,随机分为依诺肝素抗凝组与非抗凝组,术后比较中年(< 60岁)、老年(60~74岁)、高龄(≥75岁)肝素抗凝组与非抗凝组住院期间出血事件及术后1年内主要心脑血管不良事件(MACCEs)的发生率. 结果 住院期间中年抗凝组与非抗凝组小出血发生率差异无统计学意义(21.5% vs 18.8%);老年抗凝组小出血发生率高于非抗凝组(36.4% vs 23.5%,P <0.05);高龄抗凝组小出血发生率高于非抗凝组(46.7% vs 22.4%, P <0.05);住院期间不同年龄抗凝组与非抗凝组深静脉血栓(DVT)发生率差异均无统计学意义;老年、高龄抗凝组平均住院天数长于非抗凝组(P <0.05).术后1年内中年、老年、高龄抗凝组与非抗凝组MACCEs发生率差异均无统计学意义(4.1% vs 4.3%,7.3% vs 6.6%,11.7% vs 10.3%).Kaplan-Meier曲线显示:住院期间出血事件与1年内MACCEs的发生率无相关性. 结论 对于无血栓高危因素并发症的PCI术后患者,不予肝素抗凝不增加MACCEs发生率,也不增加住院期间DVT发生率,且可减少老年、高龄患者住院期间小出血发生率及住院天数. |
| 关键词: 经皮冠状动脉介入术 依诺肝素 出血 主要心脑不良事件 年龄因素 |
| DOI：10.3724/SP.J.1008.2015.00747 |
| 投稿时间：2015-03-23修订日期：2015-07-06 |
| 基金项目:上海市科委科研计划项目(10411954900). |
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| Effect of anticoagulation with enoxaparin following percutaneous coronary intervention on clinical events among patients of different ages |
| XU Fei1,TANG Nian-zhong2,3,ZHOU Yong1,WANG Jun2,ZHENG Xing1,2* |
(1. Department of Cardiology, Municipal Hospital of Suzhou, Suzhou 234000, Anhui, China;
2. Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
3. Department of Cardiology, No.411 Hospital of PLA, Shanghai 200081, China
*Corresponding author) |
| Abstract: |
| Objective To explore the influence of enoxaparin anticoagulation following percutaneous coronary intervention (PCI) on clinical events among patients with different ages. Methods A total of 700 patients without high risk of stent thrombosis complications such as no-reflow and coronary artery dissection, who had undergone PCI in the Cardiology Department of Changhai Hospital and Suzhou Municipal Hospital from 2010 to 2014, were recruited in the present study. The patients were randomly assigned to anticoagulation therapy (enoxaparin) group or non-anticoagulantion group. The in-hospital bleeding events and main adverse cardiac and cerebral vascular events (MACCEs) in 1 year were compared between patients of the two groups of three different age periods: middle age patients (< 60 years old), old patients (60-74 years old) and advanced age patients (≥75 years old). Results There were no significant differences in the incidences of in-hospital minor bleeding between anticoagulation group and non-anticoagulation group in the middle age patients (21.5% vs 18.8%). Compared with non-anticoagulation group, in-hospital minor bleeding was significantly increased in anticoagulation groups in old patients(36.4% vs 23.5%, P <0.05)and advanced age patients (46.7% vs 22.4%, P <0.05). There were no significant differences in the incidences of in-hospital deep venous thrombosis (DVT) between anticoagulation groups and non-anticoagulation groups among various ages. The average hospital stay was significantly increased in anticoagulation group than in the non-anticoagulation group in old patients and advanced age patients(P <0.05). There were no significant differences in incidences of MACCEs in 1 year between the patients of the two groups of different ages (4.1% vs 4.3% in middle age patients, 7.3% vs 6.6% in old patients, and 11.7% vs 10.3% in advanced age patients, respectively). Kaplan-Meier curves showed that the in-hospital bleeding was not associated with MACCEs in one year. Conclusion Giving no anticoagulation does not increase MACCEs or in-hospital DVT in patients without high risk for stent thrombosis complications following PCI, and it can also reduce the in-hospital minor bleeding in old and advanced age patients. |
| Key words: percutaneous coronary intervention enoxaparin hemorrhage major adverse cardiac events age factors |
