Clinical Study Of Reasonable Amount Of Heparin In Patients With Different BMI During PCI Under The Guidance Of ACT

BackgroundAt present,with the development of Percutaneous Transluminal Coronary Intervention(PCI)technology,For the collagen exposure and tissue factor release(exogenous coagulation pathway)caused by vascular endothelial injury caused by balloon,stent and other intraoperative instruments,as well as the activation of endogenous coagulation caused by catheter,balloon,stent and other instruments,common heparin has become a widely used anticoagulant drug in perioperative period.It can effectively prevent the early thrombosis and the occurrence of no reflux during the operation of PCI,Intraoperative anticoagulation with heparin has become a very important part.During PCI,the use of heparin can be guided by the bedside rapid assay of Activated Clotting Time(ACT).ACT assay can reflect the anticoagulant effect of intraoperative heparin to a certain extent.Compared with Activated Partial Thromboplastin Time(APTT),it is fast and flexible,and can reflect the anticoagulant effect of intraoperative heparin in a timely and rapid manner.In the guidelines for the management of patients with NSTE-ACS published by the European Society of Cardiology in 2020,it is recommended that patients who do not receive GPI should be given heparin at a one-time dose of 70-100IU/kg during PCI and maintain the ACT within the range of 250-350 seconds during surgery.However,according to the recommended dose of heparin,there are still many early thrombosis and no reflux phenomenon in the actual PCI treatment.What dose of heparin is more reasonable,but there is still a lack of research in this regard.The guidelines for weight-based heparin dosing have been increasingly questioned,especially in overweight patients,where there may be limitations.In recent years,studies have shown that the higher the BMI,the greater the risk of overuse of heparin in patients.At present,there is a lack of evidence on the difference of intraoperative ACT and prognosis in patients with different BMI who received different doses of heparin during PCI.ObjectiveThe purpose of this study was to explore the effects of different doses of heparin during PCI on the ACT and prognosis of patients with different BMI within the dose range recommended by guidelines.Retrospective clinical studies were conducted to preliminarily know whether patients with different BMI should be given different doses of heparin in order to achieve better anticoagulant effect during PCI and better prognosis,so as to provide reference for more reasonable application of heparin during PCI.MethodsA total of 270 patients diagnosed with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)and receiving PCI from August,2020 to February,2021 in the department of cardiovascular medicine of the china-japan Union hospital of jilin university were collected as study subjects.All patients received different doses of heparin within the recommended heparin dosage range when receiving PCI.Some patients were given heparin dosage according to 70U/kg before PCI,while others were given heparin dosage according to 100U/kg before PCI.Patients were grouped according to BMI: those with BMI < 18.5 were divided into the underweight group,those with 18.5≤BMI≤23.9 were divided into the normal weight group,those with 24.0≤BMI≤27.9 were divided into the overweight group,and those with BMI≥28 were divided into the obese group.ACT before PCI,ACT 5 minutes after administration of unfractionated heparin,ACT 30 minutes after administration of unfractionated heparin were measured in each patient.If the operation lasted longer than 30 minutes,ACT was measured every 30 minutes and 5minutes after heparin supplementation.Each patient was observed for 12 hours after the operation to observe the occurrence of early thrombosis during PCI,no reflow or slow flow of coronary arteries and bleeding events within 12 hours after the operation.The differences in ACT during PCI between the 70IU/kg group and the 100IU/kg group were compared among different BMI groups,as well as the differences in the occurrence of early intraoperative thrombosis during PCI,the absence of coronary reflow or slow blood flow,and bleeding events within 12 hours after PCI.Results:Patients with different BMI and heparin dose were grouped into groups.There were no significant differences in baseline data of age,height,smoking history,complicated diseases(hypertension,diabetes and old myocardial infarction,etc.)and antithrombotic drugs used during perioperative period of PCI among patients with different groups.Among patients with BMI < 18.5,the percentage of ACT below the target range in the 70IU/kg group was higher than that in the 100IU/kg group(56.5%vs18.2%),the difference in ACT distribution between the two groups was statistically significant(P < 0.05).Among patients with18.5≤BMI≤23.9,there was no significant difference in intraoperative ACT between the 70IU/kg group and the 100IU/kg group(P > 0.05).Among patients with 24≤BMI≤27.9,there was no significant difference in intraoperative ACT between the 70IU/kg group and the 100IU/kg group(P > 0.05).Among patients with BMI≥28,the percentage of ACT above target range in the 70IU/kg group was less than that in the100IU/kg group(7.4%vs54.8%),and the difference in ACT distribution between the two groups was statistically significant(P > 0.05).In patients with BMI < 18.5,the incidence of early thrombotic events was lower in the 100IU/kg group than in the 70IU/kg group(OR = 0.023,P < 0.05).Heparin dose was an independent risk factor for early thrombotic events in patients with BMI < 18.5(95%CI: 0.001-0.404).Among patients with BMI≥28,the incidence of bleeding events in the 100IU/kg group was higher than that in the 70IU/kg group(OR = 8.696,P < 0.05).Heparin dose was an independent risk factor for bleeding events in patients with BMI≥28(95%CI: 1.008-74.995).Conclusions:1.Within the guide-recommended heparin dose range,100IU/kg heparin dose is a more reasonable choice for patients with BMI < 18.5(low body weight).2.For patients with 18.5≤BMI≤23.9(normal weight)and24≤BMI≤27.9(overweight),There was no significant difference in patients given heparin at 100IU/kg versus 70IU/kg.3.For patients with BMI≥28(obese),a dose of heparin calculated at70IU/kg is a more reasonable choice.For NSTE-ACS patients with severe vascular lesions,ACT should be measured several times during PCI to accurately evaluate the anticoagulant effect of heparin.For patients with substandard ACT,heparin should be supplemented in time to achieve the standard ACT.