冠状动脉支架植入术后低分子肝素对近期疗效的影响

目的观察冠状动脉支架植入术后应用低分子肝素(LMWH)对近期心脏事件、心肌供血、出血风险、血栓形成的影响.方法自1977年1月至2000年4月167例行支架术的冠心病患者,随机分为对照组(83例)、LMWH组(84例).对照组术前术后常规应用阿司匹林和噻氯匹啶;LMWH组术前术后在应用阿司匹林和噻氯匹啶的基础上,加用LMWH0.4ml,皮下注射,1次/12h,连续10天.观察两组血栓形成、出血并发症、心绞痛发作及心肌缺血改善情况.结果对照组有2例出现亚急性血栓,而LMWH组没有发生(P＞0.1),两组均未发生需要输血的严重出血,LMWH组心绞痛发作次数及心肌缺血总负荷均较对照组少(P＜0.01).结论支架植入术后应用LMWH可降低心脏事件发生,改善心肌缺血,且出血并发症少,应用较为方便安全.

The Short-term Effect of Subcutaneous Low Molecular Weight Heparin on Heart Events After Successful Intracoronary Stent Implantation

Objective: To observe the effects of low molecular weight heparin (LMWH) on reducing angina and improving myocardial ischemia. To observe bleeding complications of LMWH in patients with intracoronary stem implantation. Methods: 167 patients with coronary artery disease underwent intracoro-nary stent implantion from Jan. 1997 to April 2000 were randomly divided into two groups: LMWH group (n=83); Control group (n=84). Control group was given aspirin and ticlopidine as usual, and LMWH group was given additional LMWH (0.4 ml q 12 h for 10 days). Results: Intracoronary thrombosis after stent implantation occurred in two cases in control group. However this didn't occur in LMWH group ( P >0.1). In LMWH group was lower chance of both angina and total ischemia load than in control group ( P <0.01). However, there was no significant difference in bleeding complication between two group. Conclusion: Subcutaneous LMWH after intracoronary stent implantation can reduce the chance of angina and myocardial ischemic, but without serious bleeding complication. The routine use of LMWH shows nore convenience and ease of use.