The Safety And Efficacy Of Bivalirudin In PCI After Thrombolytic Therapy In Patients With Acute STEMI

Objective:To observe the safety and efficacy of bivalirudin in primary percutaneous coronary intervention(PCI)after thrombolytic therapy in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:A total of 172 STEMI patients accepted primary PCI following thrombolytic therapy within 24 hours in Baoding NO.1 central hospital from January 2016 to October 2020 were collected.According to the different anticoagulant therapy regimens during PCI,these patients were divided into bivalirudin group and heparin group.Baseline data of all patients were collected,including age,gender,systolic blood pressure,diastolic blood pressure,smoke history,body mass index(BMI),previous medical history,creatinine,alanine transaminase,platelets,hemoglobin,left ventricular ejection fraction,blood glucose,blood lipid,drug combination,and Killip classification.The use of antithrombotic drugs,coronary angiography and intervention features were collected.The adverse events during hospitalization were observed:major adverse cardiovascular and cerebrovascular events(MACCE),acute stent thrombosis and major bleeding events.The indicator of anticoagulant efficacy: activated clotting time(ACT)measured during the operation,including the initial value,the values of 10 minutes after medication,30 minutes after medication and before the end of operation.Results:1.There were 172 patients enrolled,including 74 patients(43%)in the bivalirudin group and 98(57%)in the heparin group.There were no significant differences in age,gender,systolic blood pressure,diastolic blood pressure,smoke history,BMI,previous medical history,and baseline data such as creatinine,alanine transaminase,platelet,hemoglobin,left ventricular ejection frection,blood glucose,blood lipid,drug combination,and Killip grade between both groups.There were no significant differences in coronary lesions and preoperative and postoperative thrombolysis in myocardial infarction(TIMI)grades between both groups.The application of antithrombotic drugs,including antiplatelet drugs,anticoagulant and thrombolytic drugs had no statistical differences(P >0.05).2.In terms of adverse events,bivalirudin group observed 1 event of MACCE(1.4%),with 1 case of death.Heparin group observed 3 events of MACCE(3.1%),with 2 death events and 1 ischemic stroke event.There was no statistical difference between both groups in MACCE(P >0.05).No acute stent thrombosis was observed in both groups.There were 2 major bleeding events in the bivalirudin group and 11 in the heparin group.The incidence of major bleeding events in the bivalirudin group was lower than the heparin group(2.7% vs.11.2%),with statistical significance(P <0.05).3.In terms of the anticoagulation effect,the initial ACT values were200.75±57.84 s and 194.85±43.02 s in the bivalirudin group and the heparin group respectively,with no significant difference(P >0.05).After 10 min of medication,the ACT value was 360.15±31.63 s in the bivalirudin group and351.70±37.50 s in the heparin group and both groups met the anticoagulation standard,with no significant difference(P >0.05).After 30 min of medication,the ACT value in the bivalirudin group(350.19±16.79s)was higher than heparin group(333.71±33.0s),with statistically significant difference between both groups(P <0.001).Before the end of operation,the ACT value of bivalirudin group(344.64±13.00s)was stable and the heparin group(318.63±17.07s)was lower,with statistical difference(P <0.001).Conclusion:In the interventional therapy after thrombolysis for acute STEMI patients,compared with heparin,the use of bivalirudin as an anticoagulation agent can reduce the incidence of major postoperative bleeding events without increasing the risk of ischemic events.After the application of the drug,the anticoagulant effect is rapid and stable,and the use of bivalirudin is safe and feasible.