Bivalirudine And Heparin In Patients With Acute Myocardial Infarction Clinical Study On Risk Of Bleeding

Background and purposeAt present,with the continuous improvement of social living standards in China,the number of patients with coronary heart disease caused by hypertension,hyperglycemia,hyperlipidemia and other diseases is increasing.A series of diseases caused by coronary heart disease have brought tremendous economic and mental pressure to patients and their families.Acute myocardial infarction(AMI)is the most serious one,and its occurrence has also increased significantly.Trends: timely and early opening of occluded coronary artery is the key to the treatment of AMI;traditional drug therapy can alleviate symptoms to a certain extent,but can not fundamentally solve the problem of coronary artery stenosis;Coronary artery bypass grafting(CABG)can solve serious vascular lesions under indications,but it is not the preferred treatment because of surgery,long hospital stay,etc.With the continuous renewal and progress of percutaneous transluminal coronary intervention(PCI)technology in China,emergency PCI has become the main means of opening occluded blood vessels;however,due to the use of anticoagulants during surgery,the risk of bleeding is increased,and caution should be taken in choosing anticoagulant drugs;although traditional anticoagulant heparin has more.Advantages,but because it can induce the occurrence of thrombocytopenia and other deficiencies,affect the safety of PCI.Bivalrudine is a new anticoagulant drug for PCI.It can quickly detach from thrombin.Its half-life is only 25 minutes,and it can quickly fail.At the same time,it does not increase platelet activation,nor does it cause HIT.It has rapid effect and low risk of bleeding.This experiment mainly observed the safety and effectiveness of bivalirudine and heparin in patients with AMI during PCI.MethodFrom March 2018 to December 2018,95 patients with AMI undergoing PCI in our hospital were randomly divided into bivaludin group and heparin group.The general data including age,sex,history of hypertension and diabetes mellitus,smoking and drinking history,BMI,CRUSADE bleeding score,stent length,number of stents,operation time,contrast agent,preoperative,intraoperative and postoperative prothrombin time were observed and analyzed.Prothrombin time(PT),Activated partial thromboplastin time(APTT),Thrombin time(TT)coagulation indicators,the incidence of bleeding and MACE events(recurrent angina pectoris,heart failure,re-infarction,death)were compared between the two groups.?Result1.There was no significant difference in general characteristics(gender,age,smoking history,drinking history,hypertension prevalence,diabetes prevalence,BMI,CRUSADE bleeding score,stent length,number of stents,operation time)between the two groups(P > 0.05).2.PT,APTT,TT before operation,PT,APTT,TT immediately after operation and PT,APTT,TT 6 hours after operation showed no significant difference in coagulation function at different time points(P > 0.05).3.The main bleeding occurred in 1 case of bivalrudin group and 9 cases of heparin group,all of which were type 2 bleeding.Bivalrudin group was safer than heparin group.4.The incidence of MACE events was lower in 0 cases than that in 7 cases of heparin group.ConclusionCompared with heparin group,bivalidine group had lower incidence of bleeding and lower incidence of MACE events during PCI in AMI,so its safety was relatively higher.