| Objective: Coronary heart disease (CHD) is one of the usual diseases leads people to death who is over 40 years, which is more prevalence in men. Recently, percutaneous coronary intervention (PCI) is recognized as one of effective treatment to CHD. The myocardial injury during PCI is associated with procedural complications such as incidental side branch occlusion and thrombus formation. Therefore, anticoagulation is a very important step during PCI. Generally, unfractionated heparin is used as the first choice of anticoagulation. However, the sensitiveness and metabolism of UFH differ with different patients, and it is even harder for us to test its pharmacodynamics and pharmacokinetics. Many prospective, controlled clinical trials had investigated the use of LMWH vs. UFH in the treatment of PCI, made LMWH the first choice for anticoagulation during PCI. PCI treatment might cause elevation of biochemical markers (cTnI, MYO, CK-MB) in certain patients because of myocardial injury, therefore, anticoagulant is presenting to these patients in order to alleviate the injury caused by PCI procedure. Experiment we had done showed no statistic significance between LMWH and dalteparin during elective PCI, supporting the use of dalteparin in elective PCI. This research focuses on influence of using different doses of dalteparin on myocardial injury in elective PCI, probing into the optimal dose of dalteparin in the treatment of elective PCI.Methods: From August 2006 to December 2010, A total of 294 patients (56.4±9.8years, female 23.1%) with CHD undergoing elective PCI were divided into 3 groups administered different doses of dalteparin via artery sheath: Group 1(66patients, 55.0±9.9 years, female 22.7%, administered dalteparin 10000U), Group 2 (39 patients, 57.2±9.3 years, female 35.9%, administered dalteparin 5000U) and Group 3 (189 patients, 56.8±9.8 years, female 20.6%, administered dalteparin 120U/kg). Baseline characteristics(age, gender, renal function, mean number of stents per patient, prevalence of smoking, diabetes, hypertension, high LDL-C)were matching. Before the treatment of PCI, all the patients were administered oral aspirin 75-150mg once a day, clopidogrel 75 mg once a day and a regular use of LMWH subcutaneously twice a day at least 3 days. LMWH was used until 12 hours before PCI. All the patients were administered dalteparin 5000 IU firstly before selective coronary angiography, additional dose of 5000 IU was given before PCI procedure in group 1, no supplementary dalteparin was given in group 2. In the group 3, the dose of dalteparin was supplement to 120 IU/kg to a maximum of 10,000 U. For patients with a transradial approach, the sheath was withdrawn immediately after PCI; for patients with a transfemoral approach, the sheath was withdrawn after ACT<180s. The subcutaneous LMWH was continued until hospital discharge. Blood samples were collected 20-24 hours after PCI to test the markers of myocardial injury. Major adverse cardiac events including death, myocardial infarction, recurrent angina and emergent revascularization during hospitalization were recorded. Continuous variables are presented as mean±standard deviation and categorical variables are presented as percentages using SPSS software version 13.0. Differences between the three groups were assessed using ANOVA or Nonparametric Tests.Results: The separately cTnI value in 3 groups were 0.285 (0.200, 0.910) ng/ml, 0.310 (0.200, 0.599) ng/ml, 0.433 (0.237, 0.826) ng/ml. MYO value in 3 groups were 20.90 (14.50, 24.20) ng/ml, 15.90 (13.50, 21.45) ng/ml, 22.10 (17.60, 30.30) ng/ml. There were no statistic significant difference between the 3 groups in cTnI (P=0.507) and MYO (P=0.078). There was no significant deference in major adverse cardiac events among the 3 groups. The incidence of minor bleeding was similar between the three groups. For major bleeding rate, further study was needed.Conclusions: This research probed into the efficacy of different doses of dalteparin in elective PCI. This study showed no statistic significant difference using different doses of dalteparin in elective PCI, supporting the dose of 5000U and 120U/kg in elective PCI.
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