The Safety And Efficacy Of Application Of Hepatin Bridge Bivalirudin In Elective Percutaneous Coronary Intervention

Objective: This study aimed to evaluate the safety and efficacy of heparin bridge bivalirudin in elective percutaneous coronary intervention,and to study the optimal dose of heparin bridge bivalirudin in percutaneous coronary intervention,so as to reduce the medical cost.Methods:Preoperative oral administration of clopidogrel 300 mg and aspirin 300mg;After PCI,long-term aspirin was given at 100mg/d and clopidogrel at 75mg/d for at least one year.The optimal dose of heparin bridge bivalirudin was screened by preliminary experiments.Coronary angiography and PCI were performed via the right radial artery.After successful paracentesis,heparin group was injected via arterial sheath(produced by Shanghai First Biochemical Pharmaceutical Company;Specification:12500U/piece)100U/kg;50% of the standard dosage of bivalirudin(produced by Shenzhen Salubris Pharmaceuticals Company;Specification: 250mg/bottle)after intravenous injection of heparin 3000U;In the bivalirudin group,the standard dosage of bivalirudin was used,the loading dose of bivalirudin was 0.75mg/kg,and the maintenance dose was 1.75mg/kg/h.ACT was detected 10 min,30min after administration(bivalirudin),at the end of surgery and at 2 hours after surgery.ACT was detected 10 min,30min after the beginning of PCI,at the end of surgery and at 2 hours after surgery in the heparin group.ACT was detected in the catheter room with a whole blood coagulation analyzer and a test paper.ACT extended 250 s was taken as the standard of reaching the anticoagulation standard in PCI.If the ACT detected in PCI did not reach the standard,the drug was added again until the ACT value reached the standard.Patients in each group were recorded for age,gender,weight,previous history,ACT,major organ bleeding and local hematoma,and major adverse cardiovascular events(MACE)within 30 days.Safety measures: bleeding within 30 days and major adverse cardiovascular events.Effectiveness evaluation index: ACT value and ACT compliance rate.Results:A total of 59 patients were included in this study,including 20 in the common heparin group,29 in the bivalirudin(50% standard dosage)group,and 10 in the bivalirudin group.There was no significant difference in baseline data among the three groups.After 10 min,30min,postoperative,and 2h postoperative ACT analysis by Kolmogorov-Smirnov test,it was found that there were significant differences among the three groups at 10 min,30min,and postoperative,and that the bivalirudin group was higher than the bivalirudin group(50% standard dosage),and the bivalirudin group(50% standard dosage)was higher than the heparin group.There was no significant difference among the three groups at 2h postoperative.ACT 250 s was used as the standard of anticoagulant compliance during PCI.The ACT compliance rates of the three groups were described and compared 10 min,30min,postoperative and 2h postoperative.It was found that the ACT compliance rates at 10 min after administration of the three groups were 60.00%,100.00%,100.00%.The ACT compliance rates at 30 min after administration of the three groups were 65.00%,100.00%,and 100.00%.The postoperative ACT compliance rate was 75.00%,96.55% and 100.00% in the three groups.The ACT compliance rate 2 hours after surgery was 57.14%,100% and 50% in the three groups.No severe bleeding occurred in the three groups,1 mild bleeding event occurred in the heparin group,and no mild bleeding event occurred in the bivalirudin group or the bivalirudin group(50% of the standard dosage).There was no significant difference in the incidence of cardiac death,all-cause death,re-infarction,stent thrombosis and target vessel revascularization between the three groups during hospitalization and within 30 days.Conclusion:In summary,This study showed that heparin 3000 U bridge 50% standard dosage of bivalirudin had similar anticoagulant effect and higher safety during elective percutaneous coronary intervention.Heparin 3000 U bridge 50% standard dosage of bivalirudin can be used safely and effectively in elective percutaneous coronary intervention.