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ACC 2014：比卢伐定减少PPCI大出血作用被夸大？

2014-04-02 cath 医学论坛网

比卢伐定PPCI大出血
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2014年美国心脏病学会年会（ACC 2014）公布的HEAT-PPCI研究表明，在直接经皮冠状动脉介入治疗(PPCI)、同时选择性应用阿西单抗和术前双重抗血小板治疗的ST段抬高性心肌梗死(STEMI)患者中，应用比卢伐定不优于普通肝素。比卢伐定与患者不良心血管事件(心肌梗死或支架血栓)增加相关。而且比卢伐定并不像之前吹捧的那样可减少患者大出血事件;但该研究中，医生行PPCI途径多为经桡动脉穿刺。

2014年美国心脏病学会年会（ACC 2014）公布的HEAT-PPCI研究表明，在直接经皮冠状动脉介入治疗(PPCI)、同时选择性应用阿西单抗和术前双重抗血小板治疗的ST段抬高性心肌梗死(STEMI)患者中，应用比卢伐定不优于普通肝素。比卢伐定与患者不良心血管事件(心肌梗死或支架血栓)增加相关。而且比卢伐定并不像之前吹捧的那样可减少患者大出血事件;但该研究中，医生行PPCI途径多为经桡动脉穿刺。

研究将行PPCI的1829例STEMI患者(平均年龄63岁，女性29%，糖尿病13%)随机分至比卢伐定联合阿西单抗(n = 915)和普通肝素联合阿西单抗(n = 914)两组，排除活动性出血、研究药物不耐受的患者。受试者的合并用药(术前ADP受体阻滞剂)为99.6%。随访28天，主要有效性终点为全因死亡、卒中、心肌梗死和未计划的血运重建，主要安全性终点为大出血发生率。

结果显示，穿刺行桡动脉路径、血栓切除、置入药物洗脱支架的比例分别为80%、59%和80%。比卢伐定和肝素组的阿西单抗应用率分别为13.5%和15.5%，两组的主要有效性转归分别为8.7%和5.7%(P= 0.01)。

研究的局限性为单中心和开放标签设计。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1649468, encodeId=27ae164946810, content=<a href='/topic/show?id=c3fc145656c' target=_blank style='color:#2F92EE;'>#PPCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14565, encryptionId=c3fc145656c, topicName=PPCI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b1bd23829113, createdName=longqijun256, createdTime=Sun Jan 11 15:18:00 CST 2015, time=2015-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316117, encodeId=b3d3131611e97, content=<a href='/topic/show?id=7a1c4360e6e' target=_blank style='color:#2F92EE;'>#大出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43607, encryptionId=7a1c4360e6e, topicName=大出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aad0444, createdName=cmsvly, createdTime=Fri Apr 04 00:18:00 CST 2014, time=2014-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1324911, encodeId=e54f1324911ae, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Apr 04 00:18:00 CST 2014, time=2014-04-04, status=1, ipAttribution=)]
    2015-01-11 longqijun256

    #PPCI#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1649468, encodeId=27ae164946810, content=<a href='/topic/show?id=c3fc145656c' target=_blank style='color:#2F92EE;'>#PPCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14565, encryptionId=c3fc145656c, topicName=PPCI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b1bd23829113, createdName=longqijun256, createdTime=Sun Jan 11 15:18:00 CST 2015, time=2015-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316117, encodeId=b3d3131611e97, content=<a href='/topic/show?id=7a1c4360e6e' target=_blank style='color:#2F92EE;'>#大出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43607, encryptionId=7a1c4360e6e, topicName=大出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aad0444, createdName=cmsvly, createdTime=Fri Apr 04 00:18:00 CST 2014, time=2014-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1324911, encodeId=e54f1324911ae, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Apr 04 00:18:00 CST 2014, time=2014-04-04, status=1, ipAttribution=)]
    2014-04-04 cmsvly

    #大出血#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1649468, encodeId=27ae164946810, content=<a href='/topic/show?id=c3fc145656c' target=_blank style='color:#2F92EE;'>#PPCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14565, encryptionId=c3fc145656c, topicName=PPCI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b1bd23829113, createdName=longqijun256, createdTime=Sun Jan 11 15:18:00 CST 2015, time=2015-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316117, encodeId=b3d3131611e97, content=<a href='/topic/show?id=7a1c4360e6e' target=_blank style='color:#2F92EE;'>#大出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43607, encryptionId=7a1c4360e6e, topicName=大出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aad0444, createdName=cmsvly, createdTime=Fri Apr 04 00:18:00 CST 2014, time=2014-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1324911, encodeId=e54f1324911ae, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Apr 04 00:18:00 CST 2014, time=2014-04-04, status=1, ipAttribution=)]
    2014-04-04 12498568m50暂无昵称

    #ACC#

    0