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心血管外科术后阿加曲班与肝素动静脉冲洗的抗凝效果比较
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Journal Article
心血管外科术后阿加曲班与肝素动静脉冲洗的抗凝效果比较
2018
Overview
R654; 目的 比较术后阿加曲班与肝素两种方法实施动静脉冲洗抗凝的效果,观察其是否能有效预防肝素诱导的血小板减少症(HIT)及其并发症的发生.方法 回顾性分析2015年12月-2018年2月中国医学科学院阜外医院心血管外科术后患者的临床资料,根据术后抗凝的不同分为肝素动静脉抗凝组(肝素组,n=350,给予含10mg肝素的生理盐水250ml),阿加曲班动静脉抗凝组(阿加曲班组,n=396,给予含2.5mg阿加曲班的生理盐水250ml),监测两组血小板数量、肝、肾功能及凝血指标的变化,记录两组发生的出血或血栓事件,两组HIT相关4Ts评分及HIT抗体阳性患者数量及并发症发生情况.结果 两组患者基础临床资料差异无统计学意义(P＞0.05).术前及术后当天两组患者血小板计数差异无统计学意义(P＞0.05),术后第1天及第5天后肝素组血小板明显低于阿加曲班组[(137.7±44.8)×109/L vs.(144.9±49.9)×109/L,P=0.039;(122.8±50.0)×109/L vs.(135.7±57.7)×109/L,P=0.030).根据4Ts评分法诊断,肝素组有13例患者4Ts为中高分,其中7例患者HIT抗体阳性(2.0％),抗体阳性患者启动标准的阿加曲班抗凝治疗.阿加曲班组有5例4Ts中高分,2例HIT抗体阳性(0.5％),启动标准的阿加曲班抗凝治疗,未发生出血事件.肝素组总体血栓事件较阿加曲班组多.术后两组肝肾功能及凝血指标差异无统计学意义(P＞0.05).结论 心血管外科术后常规使用阿加曲班行动静脉冲洗抗凝对血小板数量影响小,可减少HIT的发生,同时无出血风险.
Publisher
100037,北京 阜外医院SICU、中国医学科学院/北京协和医学院国家心血管病中心、心血管疾病国家重点实验室
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