比伐卢定联合低分子肝素在急性脑梗死机械取栓术后抗凝治疗中的应用

Application of bevaludine combined with low-molecular-weight heparin in anticoagulant therapy after mechanical thrombectomy for acute cerebral infarction

摘要:

目的 观察比伐卢定联合低分子肝素在急性脑梗死机械取栓术后抗凝治疗中的应用效果。方法 采用前瞻性巢式病例研究法，以血管内机械取栓术后接受低分子肝素抗凝治疗的急性脑梗死病例作为单纯肝素组（60例），接受比伐卢定联合低分子肝素抗凝治疗作为比伐肝素组（60例）。比较两组凝血功能、康复性评估指标及不良事件发生率。结果 在停药即刻、停药1、8、24及48 h两组活化凝血时间、活化部分凝血活酶时间均高于用药前（P<0.05），两组间比较，差异无统计学意义（P>0.05）。术后6及12个月，比伐肝素组的Barthel评分、Fugl-Meyer评分高于单纯肝素组，改良Rankin量表（MRS）评分低于单纯肝素组（P<0.05）。比伐肝素组不良事件发生率（11.67%）与单纯肝素组（16.67%）比较，差异无统计学意义（P>0.05）。结论 比伐卢定联合低分子肝素应用于急性脑梗死机械取栓术后抗凝效果好，且更利于术后康复。

Abstract:

Objective To observe the effect of bevaludine combined with low-molecular-weight heparin in anticoagulant therapy after mechanical thrombectomy for acute cerebral infarction.Methods Using prospective nested case-control study， the acute cerebral infarction patients who received anticoagulant therapy with low-molecular-weight heparin after endovascular mechanical thrombectomy were taken as heparin alone group （60 cases）， and those who received anticoagulant therapy with bivalirudin combined with low-molecular-weight heparin were selected as bivalirudin-heparin group （60 cases）. The coagulation function， rehabilitation evaluation index， and incidence of adverse events were compared between the two groups.Results The activated coagulation time and activated partial thromboplastin time of the two groups immediately and 1， 8， 24， and 48 hours after drug withdrawal were significantly higher than those before the drug use （P <0.05）， but there were no significant differences between the groups （P >0.05）. At 6 and 12 months after operation， the bivalirudin-heparin group had significantly higher Barthel score and Fugl-Meyer score and a significantly lower modified Rankin Scale score compared with the heparin alone group （P <0.05）. There was no significant difference in the incidence of adverse events between the bivalirudin-heparin group and the heparin alone group （11.67% vs 16.67%， P >0.05）.Conclusions Compared with low-molecular-weight heparin alone， bivalirudin combined with low-molecular-weight heparin has a better anticoagulant effect after mechanical thrombectomy for acute cerebral infarction and is more conducive to postoperative recovery.