The Effect And Safety Evaluation Of Tirofiban Hydrochloride Combined With Low Molecular Weight Heparin On Acute Coronary Syndrome

Objective:To discuss the efficacy and safety of quadruple therapy:aspirin,clopidogrel, low molecular weight heparin(LMWH)and tirofiban hydrochloride when treat patients with unstable angina(UA)or non-ST-segment elevation myocardial infarction(NSTEMI). Method:57 patients with UA or NSTEMI in observation group and 60 in control group of all 117 selected hospitalized patients administered aspirin 300mg and clopidogrel 300mg at initial dose,then aspirin 100mg and clopidogrel 75mg everyday.On this base, injected intravenously tirofiban in observation group,the loading dose was 0.4μg.kg^-1min^-1by intravenous drip in 30 minutes,then maintenance dose was given 2～3days of 0.1μg.kg^-1min^-1;at the same time 2～3 days of injected hypodermicly LMWH (enoxapain:40mg/12h,nadroparin:0.4ml/12h),then used continuously 3～4 days after stoping tirofiban(enoxapain:1mg/10kg/12h,adroparin;0.1ml/10 kg/12h).While only LMWH was given in control group 5-7days(enoxapain:lmg/kg/12h,nadroparin: 0.1ml/10kg/12h).Result:All-cause death,refractory angina pectoris,myocardial infarction again in observation group in 7 days were 1(1.7%),1(1.7%),0(0%) respectively;while 7(11.7%),8(13.3%)and 3(5%)in control group.It was showed that there was difference in All-cause death,refractory angina pectoris between observation group and control group(P＜0.05),but no difference in myocardial infarction again (P＞0.05).No serious hemorrage in all two groups,4(7%)in observation group while 2(3%)in control group occurred moderate hemorrage,there is no statistical difference in two groups(P＞0.05),but 14(24.6%)in observation group and only 5(8.3%)in control group occurred mild hemorrage,now there was statistical difference in two groups (P＜0.05).No changes of hemoglobin in all two groups during observing period.There was no significant change in platelet count in control group,however,56 in 57 patients' platelet count in observation group decreaced after being given firofiban comparing with before(P＜0.05),but it's all in normal range.1 case developed serious thrombocytopenia after tirofiban given,but no complication of hemorrage.Though APTT value increased in observation group(P＜0.05),still not excceded its two times value of normal;in control group,APTT value also increased mildly after using LMWH,but no statistical difference. (P＞0.05).Conclusion:Quadruple therapy(aspirin,clopidogrel,LMWH and tirofiban hydrochloride)is safe when treat patients with UA or NSTEMI under the condition of detecting platelet count strictly and continuously.There is difference between observation group and control group for decreasing incidence in all-cause death,refractory angina pectoris,but no difference for myocardial infarction again in 7 days.