Bivalirudin Compared With Heparin For Patients With Acute Myocardial Infarction After PCI About Evaluation Of Efficacy

Objectives This study compared the efficacy and safety for acute myocardial infarction patients with percutaneous coronary interventional therapy used bivalirudin, heparin and heparin combined tirofiban, in order to select the best anticoagulant treatment.Methods A total of 153 AMI patients were enrolled into this study from June 2013 to December 2014.The patients receiving PCI were randomly divided into three groups after coronary angiography(CAG), Heparin group(n=55), Heparin+ Tirofiban group(n=31)and Bivalirudin group(n=67). 1Heparin group(n=55 cases, 100 u/kg, then low molecular weight heparin 0.4 ml subcutaneous injection about 1/12 h).2Heparin + Tirofiban group(n = 31 cases, heparin 100 u/kg through sheath tube injection, tirofiban 5 ug/kg intravenous injection, then 0.075 ug/(kg*min) maintain intravenous injection for 24 hours, then the low molecular weight heparin 0.4 ml subcutaneous injection 1/12 h). 3 Bivalirudin group(n =67 cases, 0.75 mg/kg intravenous injection, 1.75 mg/kg*h intravenous pumping until the procedure finished, postoperative four hours 0.2 mg/kg*h pump the rest into the vein, then0.4 ml low molecular weight heparin subcutaneous injection 1/12 h). All patients received aspirin and clopidogrel antiplatelet therapy,auxiliary drugs including nitrates and statin.Observed and recorded each patient’s age, gender, body weight and past medical history,the routine blood, renal function, blood coagulation function, activated clotting time(ACT),CTn I and NT- por BNP of preoperative, postoperative immediate, postoperative 1 h, 2 h,24 h after surgery, the electrocardiogram(ECG) at preoperative and postoperative 1 h,major internal bleeding and local hematoma, major adverse cardiac events(MACE) within30 days, etc. Therapeutic effect evaluation indexes: the procedural success rate of PCI,postoperative TIMI blood flow grade, percentage of ST segment fell back, platelet,coagulation function, ACT, renal function, CTn I and NT- por BNP. Safety evaluation indicators: incidence of bleeding and major adverse cardiac events within 30 days.Statistical methods: Related indexes were analysed by the Statistical Package for the Social Sciences 17.0(SPSS17.0) statistical software, all count data were expressed as a percentage, using x2-test or Fisher x2-test; Conform to the normal distribution of measurement data showed by average ±standard deviation( sx ±), using two independent sample t-test, non-normal distribution of measurement data by converting logarithmicnormal distribution, expressed as a median, using t-test. The difference was statistically significant if P< 0.05.Results The procedural success rate of PCI, TIMI blood flow grade, percentage of ST segment fell back, NT- por BNP levels were similar in three groups,(P > 0.05).Bivalirudin group had the higher ACT levels than those in Heparin group and Heparin+Tirofiban group at immediately after the PCI procedure,(P<0.05), however, Bivalirudin group had the lower ACT levels than those in Heparin group and Heparin+ Tirofiban group at 1-hour and 2-hour after the PCI procedure,(P<0.05). There was no severe bleeding,but the mild bleeding rate within 30 days during three groups were meaningful,(P<0.05).The levels of blood coagulation function, platelet, Renal function and CTn I were similar at 24-hour after the PCI procedure.1 case of patients with cardiac death in Heparin group, there were no again infarction, stent thrombosis, target vessels reascularization during the three groups within 30 days,(P>0.05).Conclusions Bivalirudin Compared with heparin or heparin+ tirofiban has the similar therapeutic effect for the acute myocardial infarction patients with emergent percutaneous coronary intervention, but bleeding rate was less than heparin or heparin+ tirofiban.Bivalirudin is safe and effective for the acute myocardial infarction patients with emergent percutaneous coronary intervention.