Effect Of Bivalirudin On Coagulation Function And Prognosis In Patients With Coronary Artery Disease And Renal Insufficiency Undergoing PCI

Objective To observe activated clotting time(ACT)?thrombin time(TT)?activated partial thromboplastin time(APTT)?prothrombin time(PT)?fibrinogen(FIB)?major adverse cardiovascular and cerebrovascular events(MACCE)in 30 days ? bleeding complication and the occurrence of acute and subacute stent thrombosis through the application of domestic bivalirudin in coronary heart disease with renal insufficiency undergoing percutaneous coronary intervention(PCI),to discuss the efficacy and safety of domestic bivalirudin in these patients and if the efficacy and safety are different in female patients.Methods Patients with coronary heart disease and renal insufficiency from October2015 to August 2016 in my hospital were randomly divided into heparin group and domestic bivalirudin group according to randomized double-blind method,and divided into heparin group and bivalirudin group according to different anticoagulant drugs used in female patients.The ACT level was measured respectively in patients at before the application of anticoagulant,5min after using drugs,stopping drug immediately,30min?1h?2h after stopping drug.Activated partial thromboplastin time(APTT)?thrombin time(TT)? prothrombin time(PT)and fibrinogen(FIB)were measured respectively at before treatment?6h?24h and 72 h after the application of anticoagulant.The platelet count(PLT)was measured before anticoagulant and after the application of anticoagulant.The major adverse cardiovascular and cerebrovascular events(MACCE),postoperative bleeding complications,and stent thrombotic events were observed 30 days after outpatient through telephone or outpatient clinic.Results(1)Compared with the heparin group at 5 minutes after the treatment,immediately after the end of surgery to determine ACT,bivalirudin group was significantly greater(P<0.05).1 hour,2 hours after stopping measured ACT level,bivalirudin group was significantly lower(P<0.05).There were no significant differences between the two groups at blood coagulation and platelet after treatment(P>0.05).There were no significant differences between the two groups in the 30-day proportions of stent thrombosis,no differences in the major adverse cardiac or cerebralevent at the 30-day end point(1.11%vs 2.20%,P> 0.05).There were significant differences in the net adverse clinical events at 30 days(12.22% vs 26.38%,P <0.025).All bleeding at 30 days was abated by bivalirudin compared with heparin(11.11%vs24.18%,P<0.05).(2)For the female subgroup,the ACT level was significantly higher than that of the heparin group at 5 minutes after the treatment and immediately after the end of surgery(P< 0.05).1 hour,2 hours after stopping measured ACT level,bivalirudin group was significantly lower(P<0.05).There were no significant differences between the two groups at 30 min after stopping drug and before operation(P>0.05),no differences in the coagulation function and platelet count between the two groups(P>0.05).There were no significant differences between the two groups in the major adverse cardiac or cerebral event at the 30-day end point(0%vs 2.56%,P> 0.05),no significant differences between the two groups in the 30-day proportions of stent thrombosis.There were significant differences in the net adverse clinical events at 30days(21.88%vs 48.72%,P<0.05).All bleeding at 30 days was abated by bivalirudin compared with heparin(21.88% vs 46.15%,P<0.05).Conclusion 1.Compared with heparin,bivalirudin takes effect and recoveries more quickly,is more efficient and more saftey during PCI in patients with coronary artery disease and renal insufficiency.2.For these patients with another independent risk factor(women),bivalirudin can achieve the same antithrombotic effect and also significantly reduce the bleeding adverse events,is more efficient and more saftey.