Effect Of ACT Monitoring On Dose Adjustment And Efficacy Of Bivalirudin In Patients With STEMI Undergoing Emergency PCI

Background Currently,if conditions permit for ST-segment elevation myocardial infarction patients,it is recommended to open infarct-related coronary arteries by emergency PCI,and antithrombotic therapy and bleeding prevention should be performed throughout the treatment.The higher risk,heparin induced thrombocytopenia blood limits the application of ordinary heparin.Bivalirudin as a direct thrombin inhibitor,has the characteristics of effective quick,short action time.A series of clinical observation and experimental studies have shown that the perioperative application of Bivalirudin can reduce the risk of bleeding,but still has the risk of bleeding,and some studies have shown that Bivalirudin may increase the risk of acute stent thrombosis after emergency PCI.Objective To investigate the effect of Bivalirudin on perioperative bleeding and stent thrombosis in patients with acute st-elevation myocardial infarction(STEMI)who underwent emergency PCI by activated coagulation time(ACT)measurement.Adjust medication dose of bivalirudin according to ACT.Methods From October 2017 to December 2018 in Chest Pain Center of henan university huaihe hospital,in accordance with the guidelines for diagnostic criteria for diagnosis of patients with acute ST segment elevation myocardial infarction,altogether collected 170 cases,in strict accordance with the design of experiment of inclusion criteria and exclusion criteria,emergency operation in all patients with preoperative have been fully informed the importance of perioperative application bivalirudin.According to the attached table 8-random number table in the fourth edition of medical statistics(chief editor: Sun Zhenqiu and Xu Yongyong)published by people's health publishing house in March 2016,100 patients with acute st-segment elevation myocardial infarction were randomly divided into monitoring ACT group and non-monitoring ACT group.All bleeding cases in both groups were recorded according to the standard definition of bleeding(BARC rating)developed by the academic research association of bleeding.SPSS 23.0 was used for the statistical analysis of bleeding between the two groups.Results The P values of basic clinical data between the two groups were all greater than 0.05 without statistical significance,and the two groups were comparable.The ACT time group was monitored for 4 case of all intraoperative and postoperative bleeding events,and the bleeding incidence was 4.71%.In the non-monitoring ACT time group,18 cases of intraoperative and postoperative bleeding events occurred,with an incidence of 21.18%,P=0.01(<0.05).The ACT time group was monitored for 0 case of stent thrombosis.In the non-monitoring ACT time group,4 cases of stent thrombosis events occurred,with an incidence of 4.71%,P=0.04(<0.05).Conclusion Routine ACT monitoring of bivalirudin in the perioperative treatment of STEMI patients with PCI can significantly reduce bleeding and stent thrombosis based on the act coagulation time(ACT)monitoring results,it is effective to adjust the Bivalirudin dose according to the weight ladder.