To explore the safety and efficacy of applying Bivalirudin during perioperative period of percutaneous coronary intervention in complex high-risk and indicated patients with extracorporeal membrane oxygenation
10.3969/j.issn.1004-8812.2025.11.003
- VernacularTitle:探讨体外膜肺氧合辅助经皮冠状动脉介入治疗的高危复杂冠心病患者应用比伐芦定的安全性和有效性
- Author:
Ling YANG
1
;
Cheng-cheng YI
;
Yu PENG
;
Zheng ZHANG
Author Information
1. 兰州大学第一医院(第一临床医学院),甘肃兰州 730000
- Publication Type:Journal Article
- Keywords:
Extracorporeal membrane oxygenation;
Percutaneous coronary intervention;
Complex high-risk and indicated patients;
Heparin;
Bivalirudin;
Adverse cardiovascular events
- From:
Chinese Journal of Interventional Cardiology
2025;33(11):620-626
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the safety and efficacy of applying Bivalirudin in complex high-risk and indicated patients(CHIP)undergoing percutaneous coronary intervention(PCI)while on extracorporeal membrane oxygenation(ECMO).This study will provide additional evidence for making informed decisions regarding anticoagulation therapy during ECMO.Methods A total of 83 CHIP who underwent VA-ECMO assisted PCI in the Heart Center of the First Hospital of Lanzhou University from March 2019 to December 2022 were retrospectively enrolled as the research objects.According to the use of anticoagulant drugs during ECMO support and PCI,they were divided into Bivalirudin group(40 cases)and heparin group(43 cases).The cost of anticoagulants,coefficient of variation of activated partial thromboplastin time(APTT),APTT compliance rate,bleeding events,thrombotic events,blood product transfusion,and net adverse clinical events(NACE)at 30 days after PCI were compared between the two groups to determine the safety and efficacy of Bivalirudin in CHIP undergoing ECMO assisted PCI.Results The proportion of previous PCI(25.00％vs.4.65％),fibrinogen level[(3.52±1.14)g/L vs.(2.92±1.28)g/L],CRUSADE score[(32.00±12.69)scores vs.(26.14±10.60)scores],anticoagulation cost[1 400.00(700.00,2 100.00)RMB vs.107.69(58.74,205.59)RMB]and compliance rate of APTT[(57.76±33.11)％vs.(31.44±27.63)％]in the Bivalirudin group were higher,while the coefficient of variation for APTT[10.64(7.72,21.11)vs.19.47(10.48,31.28)]was lower than those in the heparin group.The total bleeding events(25.00％vs.46.51％),Bleeding Academic Research Consortium(BARC)1-2 bleeding events(12.50％vs.32.56％),and total thrombotic events(12.50％vs.32.56％)of the Bivalirudin group was significantly lower compared with the heparin group.Kaplan-Meier curves showed that cumulative incidence of 30-days NACE was significantly lower in the Bivalirudin group than in the heparin group.The differences between the above two groups were statistically significant(Log-rank P＜0.001).Conclusions Compared with heparin,Bivalirudin has better safety and efficacy in CHIP undergoing PCI assisted by VA-ECMO.
