磺达肝癸钠和低分子肝素治疗急性冠脉综合征疗效比较

对比磺达肝癸钠与低分子肝素(LMWH)在治疗急性冠脉综合征(ACS)中的疗效及安全性.方法 选择2009年11月至2010年8月本院确诊的ACS患者105例,按随机原则分为两组,均给予硝酸酯类、β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体阻滞剂(ARB)、他汀类、氯吡格雷、肠溶阿司匹林等基础药物治疗;在基础治疗上磺达肝癸钠组(50例)每日1次皮下注射磺达肝癸钠2.5 mg,LMWH组(55例)每日2次皮下注射LMWH 0.4 ml,均连用3～8 d.观察两组治疗期间的临床疗效,以及7 d、30 d时心血管事件和治疗期间出血的发生率.结果 磺达肝癸钠组与LMWH组总有效率比较差异无统计学意义(96.0%比92.7%,P＞0.05);7 d、30 d时心血管事件(死亡、急性心肌梗死和再发心肌梗死)的发生率比较差异也无统计学意义(7 d:4.0%比7.3%,30 d:8.0%比10.9%,均P＞0.05);两组均未发生大出血,磺达肝癸钠组轻微出血发生率明显低于LMWH组(2.0%比32.7%,P＜0.01).结论 应用磺达肝癸钠治疗ACS具有不劣于LMWH的疗效,而且有着良好的安全性,不良反应少,值得推广.

Comparison of therapeutic efficacy between fondaparinux and low molecular weight heparin for patients with acute coronary syndrome

Objective To compare the efficacy and safety of fondaparinux with that of low molecular weight heparin (LMWH) in the treatment of acute coronary syndrome (ACS). Methods One hundred and five patients with ACS admitted from November 2009 to August 2010 were randomly divided into two groups. They were all treated with nitrates, β-blockers, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), statins, clopidogrel, enteric-coated aspirin and other basic drugs. On the basis of the above treatment, the fondaparinux group patients (n=50) received hypodermic injection of fondaparinux 2.5 mg, once a day, and the LMWH group patients (n=55) received hypodermic injection of LMWH 0.4 ml, twice a day, the therapeutic course being 3- 8 days of both groups. The therapeutic efficacy, the cardiovascular event and bleeding incidences during 7 days and 30 days of the treatment were observed. Results There was no significant difference between the fondaparinux group and LMWH group in the total effective rate (96.0% vs. 92.7%, P＞0.05), also no significant differences were found between the two groups in cardiovascular events (death, acute myocardial infarction and recurrence of myocardial infarction) during 7 days and 30 days (7 days: 4.0% vs. 7.3%, 30 days: 8.0% vs. 10.9%, both P＞0.05). There was no major bleeding incident, and the incidence of minor bleeding in fondaparinux group was obviously lower than that in LMWH group (2.0% vs. 32.7%, P＜0.01). Conclusion The efficacy of fondaparinux in the treatment of ACS is not inferior to that of LMWH, and adverse events during and after its administration were significantly lower than those in LMWH group, so that fondaparinux treatment for ACS is safe and can be highly recommended.