关键词: 阿加曲班, 急性心肌梗死, 高出血风险, 经皮冠状动脉介入术, 剂量, 安全性

Abstract:

Objective To investigate the efficacy and safety of different anticoagulation intensities of arg⁃ atroban in patients with acute ST⁃segment elevation myocardial infarction（STEMI）with high blood risk after percu⁃ taneous coronary intervention（PCI）. Methods A total of 156 patients with high blood risk STEMI and PCI，were randomly divided into group A，B and C with 52 cases each. The three groups were treated with different doses of agatroban anticoagulation in PCI，and different activated coagulation time（ACT）was maintained until after sur⁃ gery. Myocardial infarction thrombolysis test （TIMI） blood flow grading，TIMI myocardial perfusion grading （TMPG）and TIMI Hemometer frame calibration（cTFC）were monitored before and immediately after PCI. The incidence of bleeding events within 7 days after PCI was recorded and major adverse cardiac events（MACE）was followed up within 6 months. Results Myocardial perfusion indexes（TIMI grading，TMPG grading，cTFC frame number）in group B were superior to those in group A immediately after PCI（P = 0.012，0.006，0.005）. Within 7 days after PCI，the incidence of bleeding events in group B was lower than that in group C（P = 0.022）. The inci⁃ dence of MACE in group B was lower than that in group A within 6 months after PCI（P = 0.038）. Conclusion In PCI for STEMI patients with high blood risk，the myocardial perfusion level in group B is better than that in group A；the incidence of bleeding events is lower than that in group C，and the incidence of MACE is lower than that in group A. ACT（250 ~ 300）s is maintained as the optimal anticoagulation regimen in group B.

Key words: argatroban, acute myocardial infarction, higher blood risk, percutaneous coronary inter?vention, dose, security