Low Molecular Weight Heparin In The Treatment Of Unstable Anglna Pectorls:Effect On Hemostatic,Fibrinolytic System And Retrospective Analysis Of Its Short－Term Efficacy

Objective (1)To investigate the anticoagulant effect of LMWH andto select a reliable parameter to detect the anticoagulant effect in patients with UAP.(2)To retrospectively analyze the short-term efficacy of LMWH compared with SH.Methods (1)40 patients with UAP were treated with LMWH(0.4～0.6ml)subcutaneously twice daily for 7 days.Blood samples were taken to assay PT,APTT,the concentration of D-dimer,the activity of t-PA,PAI,AT-III and anti-FXa before treatment, 4h and 12h after the last subcutaneous injection.(2)208 patients with UAP were divided into 2 groups.Group SH (n=98) :100mg (12500IU)intravenous infusion,once daily for 7 days;Group LMWH (n=110): 0.4～0.6ml subcutaneous infusion,twice daily for 7 days.The primary end points were nonfatal myocardial infarction,cardiac or noncardiac death and urgent revascularization 7 days within treatment.Results (1)PTR,APTT,the concentration of D-dimer,the activity of anti-FXa, t-PA and AT-III increased greatly after LMWH administration (p<0.05), meanwhile,no statistically significant differences were observed for the activity of PAI (p>0.05).(2)By 7 days,the incidence of nonfatal myocardial infarction,cardiac or noncardiac death and urgent revascularization was insignificant between the two groups (P>0.05). The incidence of composite events was 2.73% in group LMWH and 11.2% in group SH (P=0.04).Conclusions (1)Subcutaneous LMWH has continuous and effective anticoagulant efficacy,morever,it can promote the release of t-PA and activate the fibrinolytic system. (2)Anti-FXa activity is a reliable parameter for monitoring the anticoagulant effect of LMWH.(3)Subcutaneous LMWH is more effective in reducing composite cardiovascular events than intravenous SH and can improve prognosis during the acute phrase of UAP.