磺达肝癸钠在急性心肌梗死早期未血运重建患者中的应用

Application of Fondaparinux in acute myocardial infarction without revascularization at early stage

摘要:

目的：对比磺达肝癸钠与低分子肝素（Low molecular weight heparin，LMWH）在治疗急性心肌梗死（Acute myocardial infarction，AMI）早期未血运重建患者中的临床疗效与安全性。方法：入选302例未早期血运重建的AMI患者，随机分为磺达肝癸钠组（152例），LMWH组（150例），观察2组7、30 d期间的心血管事件以及治疗期间出血的发生率。结果：磺达肝癸钠组7 d内心绞痛、再发心肌梗死、死亡、恶性心律失常、心衰发生率均较LMWH组明显减少（8.6％比18.7％，2.6％比8.7％，2.6％比8.0％，3.9％比10.0％与11.8％比21.3％，P均<0．05）；磺达肝癸钠组30 d内主要不良心脏事件（包括再发心肌梗死/死亡/顽固性心肌缺血）均较LMWH组明显减少（3.9％比10.0％，3.9％比10.7％，3.3％比13.3％与8.6％比21.3％，P均<0．05）；磺达肝癸钠组出血事件较LMWH差异无统计学意义（P >0．05）。结论：磺达肝癸钠可显著降低未接受早期血运重建AMI患者的心血管事件，而且不增加出血风险。

Abstract:

Objective：To compare the efficacy and safety between Fondaparinux and low molecular weight heparin（LMWH） in treat－ing acute myocardial infarction（AMI） without revascularization at early stage. Methods:Three hundred and two patients with AMI without revascularization at early stage were randomly divided into Fondaparinux group（152 cases） and LMWH group（150 cases）. The cardiovascular event and bleeding incidences within 7 d and 30 d after the treatment in both group were observed. Results：The incidences of cardiovascular events （angina，recurrent myocardial infarction，death，vicious arrhythmia，heart failure） within 7 d in Fondaparinux group were obviously lower than those in LMWH group（8.6％ vs. 18.7％，2.6％ vs. 8.7％，2.6％ vs. 8.0％，3.6％ vs. 10.0％ and 11.8％ vs. 21.3％）. The incidences of major adverse cardiac events（recurrent myocardial infarction，death，refractory myocardial ischemia） within 30 d in Fondaparinux group were obviously lower than those in LMWH group（3.9％ vs. 10.0％，3.9％ vs. 10.7％，3.3％ vs. 13.3％ and 8.6％ vs. 21.3％）. There was no significant difference in incidences of bleeding events between the two groups. Conclusions：Fondaparinux can significantly reduce cardiovascular events without increasing bleeding events in patients with AMI but not undergoing revascularization at early stage.