Investigation And Analysis Of The Application Of Anticoagulant Drugs And Bleeding Events In PCI Patients During The Perioperative Period

Objective:Investigate the clinical characteristics of patients with percutaneous coronary intervention(PCI)and the application of perioperative anticoagulant drugs,record perioperative bleeding events,compare the safety of different anticoagulant drugs,and provide reference for clinical anticoagulant drug application.Methods:Enrolled 720 patients who underwent PCI in the First Affiliated Hospital of Shihezi University School of Medicine from May 2019 to May 2020,including non-ST-segment elevation acute coronary syndrome(NSTE-ACS)and ST-segment elevation myocardial infarction(STEMI)patients,all underwent coronary stent implantation after admission.Collect clinical data,investigate the application of perioperative anticoagulants,and record perioperative bleeding events through inquiry and physical examination.Bleeding events were judged according to the REPLACE-2 bleeding grading standard.Single factor and multivariate Logistic regression were used to analyze the influencing factors of anticoagulant drug application.After matching the propensity score,compare the safety of different anticoagulant drugs.Results:1.Basic information:Among 720 PCI patients,there were 606 males(84.2%)and 114 females(15.8%).The average age was 60.58±11.36 years old.Diagnosis of 455 cases of NSTE-ACS(63.2%)and265 cases of STEMI(36.8%):Compared with STEMI patients,NSTE-ACS patients were older(61.58±10.92 years old vs58.85±11.91 years old),and the proportion of women was higher(19.8%vs9.1%),the proportion of combined hypertension was higher(56.9%vs45.7%),the proportion of diabetes was higher(28.6%vs21.9%),the proportion of cerebrovascular disease was higher(19.8%vs8.7%),the proportion of PCI history was higher(5.8%vs5.3%),and the proportion of elective surgery was higher(88.4%vs21.5%),the proportion of multivessel disease was higher(62.9%vs55.1%),and the number of implanted stents was more(1.72±0.93 pieces vs1.44±0.67 pieces).(P<0.05).2.Anticoagulation status:720 PCI patients were treated with Bivalirudin in perioperative period in 67 cases(9.3%)and unfractionated heparin in 653 cases(90.7%).Compared with the unfractionated heparin group,the Bivalirudin group was older(72.52±11.66years old vs59.35±10.61years old),the proportion of women was higher(32.8%vs14.1%),and the BMI was lower(25.27kg/m~2±3.18vs26.18±3.13kg/m~2).The rate of combined smoking history was higher(35.8%vs58.2%),the rate of heart failure was higher(14.9%vs5.4%),the rate of combined PCI history was lower(4.5%vs12.7%),and the baseline hemoglobin was lower(141.78±14.86g/Lvs147.45±15.65g/L),the proportion of emergency surgeries was higher(49.3%vs34.9%),and the proportion of multivessel disease was higher(70.1%vs59.0%).(P<0.05).Binary Logistic regression analysis showed that older age(OR=1.102,95%CI:1.071～1.135)and emergency surgery(OR=2.203,95%CI:1.090～4.455)were the main influencing factors for the application of Bivalirudin.3.Bleeding:112 cases(15.6%)of 720 PCI patients had bleeding during the perioperative period,including27 cases(3.8%)of massive bleeding.4.The safety of anticoagulant drugs:The clinical data and recognized bleeding influence factors that were statistically different between the Bivalirudin group and the unfractionated heparin group were evaluated by propensity scores,and 49 pairs were successfully matched.After matching,the bleeding situation of the two groups was compared,and the results showed that the incidence of total bleeding and major bleeding during the perioperative period in the Bivalirudin group was lower than that in the unfractionated heparin group(P<0.05).Conclusion:1.The application of anticoagulant drugs in the perioperative period of PCI patients is still dominated by unfractionated heparin,and the application rate of Bivalirudin is low.2.PCI patients who are older and undergo emergency surgery are more inclined to choose Bivalirudin anticoagulant during perioperative period.3.The incidence of total bleeding during PCI perioperative period was relatively high,and clinicians should pay attention to it.4.The safety of Bivalirudin is better than unfractionated heparin,and it is recommended to choose Bivalirudin for anticoagulation in PCI perioperative patients with high risk of bleeding.