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在皮肤冠状动脉干预和肥胖期间的肝素剂量
Rolf P Kreutz1, Isaac G Leon1, Eric R Bain1
1Division of Cardiovascular Medicine, Indiana University School of Medicine/Indiana University Health Methodist, Indianapolis, IN.
Journal of cardiovascular pharmacology
|December 12, 2023
概括
对于穿皮冠状动脉干预的未分离的肝素剂量有显著的差异. 肥胖患者需要更低的按体重调整的氨酸剂量来达到目标激活凝固时间 (ACT) 水平.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 不分离的肝素是穿皮冠状动脉干预 (PCI) 的标准抗凝剂.
- 目前的指导方针建议以体重为基础的剂量 (70-100 U/kg) 来达到250-300秒的目标激活凝固时间 (ACT).
- 严重肥胖对肝素剂量和ACT反应的影响尚不清楚.
研究的目的:
- 调查肥胖对PCI期间未分离的肝素剂量和ACT反应的影响.
- 在接受PCI的患者中确定肝素剂量-反应变化的预测因素.
主要方法:
- 对接受PCI的424名患者进行了回顾性分析,这些患者接受了未分离的肝素.
- 数据收集包括累积的肝素剂量和ACT测量.
- 使用多变量线性回归分析来确定影响ACT的显著共变量.
主要成果:
- 观察到肝素剂量的显著变化,平均给药量为103.9±32U/kg.
- 只有49%的患者在初始推剂量下达到目标ACT (≥250秒).
- 肥胖患者需要更低的体重调整的肝素剂量来达到目标ACT.
- 在考虑基于体重的剂量后,身体质量指数是ACT的多变量分析中唯一显著的共同变量.
结论:
- 在PCI期间,未分离的肝素的治疗疗效存在很大变化.
- 肥胖与需要更低的体重调整的肝素剂量来实现治疗性抗凝剂的需求有关.
- 目前基于体重的剂量协议可能需要在肥胖人口中进行调整.
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