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Possible Effects of Plasma Troponin I, Creatine Kinase MB and Myoglobin Using Fragmin and Unfractionated Heparin in Elective Percutaneous Coronary Intervention

Author: ZhangKai
Tutor: CuiZuo；LiYongJun
School: Hebei Medical University
Course: Internal Medicine
Keywords: Heparin Low molecular weight heparin Coronary heart disease Interventional treatment Troponin Creatine kinase isoenzyme Myoglobin
CLC: R541.4
Type: Master's thesis
Year: 2008
Downloads: 34
Quote: 1
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Abstract

Objective: coronary heart disease (CHD) is one of the most common diseases of the elderly, but also led to the first cause of death by disease in humans after percutaneous coronary intervention (PCI) is a very common treatment method for the treatment of CHD. Anticoagulant during PCI is very important, usually application unfractionated heparin (UFH), sensitivity and metabolism of heparin intravenous unfractionated heparin anticoagulation there are great individual differences, heparin into the bloodstream with a variety of plasma protein binding, its anticoagulant activity is reduced to a low level, the heparin combination with endothelial cells and macrophages, which its pharmacodynamic and pharmacokinetic complicated and difficult to predict. Low molecular weight heparin (LMWH) and macrophages and endothelial cells less difficult to be the platelet fourth factor inactivation, rarely bound to plasma proteins, it replaced UFH anticoagulation in many areas due to its inherent advantages . With the large-scale application of the low molecular weight heparin has many clinical studies have shown its possible alternative to unfractionated heparin in elective PCI anticoagulant therapy. The PCI surgery can lead to postoperative troponin (cTnI), creatine kinase MB (CK-MB) and myoglobin (MYO) rise, intraoperative use of anticoagulant drugs can reduce operative myocardial injury, the aim of this study is that elective PCI by comparing UFH and LMWH after of cTnI, CK-MB and Myo elevated, further explored in patients with coronary heart disease undergoing elective percutaneous coronary interventional therapy (PCI) in the application the feasibility and effectiveness of low-molecular-weight heparin instead of unfractionated heparin. Methods: Between May 2006 to November 2007 the Department of Cardiology of our hospital patient undergoing elective PCI patients with acute coronary syndrome (Acute CoronarySyndrome, ACS) patients with a total of 106 cases. Were randomly divided into 2 groups: injection of unfractionated heparin group (54 cases), dalteparin group (52 cases), including 87 males and 19 females; aged between 37 to 77 years old, an average of 56.29 ± 9.92 years. All patients underwent preoperative application of enteric-coated aspirin 75 ~ 150mg twice daily; clopidogrel (trade name: Bonny dimensional, 塞诺菲圣德拉 Fort Pharmaceutical Co., Ltd.) 75 mg daily; PCI preoperative above drugs for at least three days. All patients underwent preoperative routine application of aspirin 75 ~ 150 mg twice daily; clopidogrel 75 mg daily; dalteparin (Dalteparin, Fragmin / of Fragmin) 5000IU subcutaneous injection once every 12 hours, at least three days, suspended 12 hours before surgery dalteparin subcutaneously injected 1. The unfractionated heparin 5000IU unfractionated heparin group was injected via the arterial sheath before PCI to complete before coronary angiography heparin supplement to 10000IU; dalteparin group directly 5000IU reached heparin sodium disposable by the sheath injection, coronary angiography after the completion of supplement dalteparin 5000IU. Blood samples were collected before treatment and 20 hours after the end of surgery censorship. Through the femoral artery approach surgery, unfractionated heparin group according to the postoperative ACT level in about four hours after PCI removal of arterial sheath removal of the arterial sheath the dalteparin group of 2 to 4 hours after injection of dalteparin. Transradial surgery after surgery to pull out of its scabbard tube. Preoperative and postoperative 20 hours blood samples were collected detection of cTnI, CK-MB and MYO. Statistical analysis: this is just a preliminary test study, unable to conclude that the results of the clinical endpoints with statistical significance, a total of 106 cases of data collection, all count data are presented as mean ± standard deviation (x ± s) or rate (% ) said the count data using independent samples t-test measurement data using the χ2 test. Results: The preoperative UFH group and LMWH group cTnI results were normal (lt; 1.0 ng / ml). The UFH group after the cTnI positive for 20 cases (37.03%), the LMWH group cTnI positive in 16 cases (30.77%); no significant differences between the two groups (P = 0.634). Troponin elevation in the UFH group three times by six cases (11.11%); troponin elevation in the LMWH group three times in four cases (7.69%); between the two groups and there is no significant difference (P = 0.787) (Table 3, Fig 1). Postoperative UFH group cTnI was 1.86 ± 3.00 ng / ml, the LMWH group was 1.54 ± 3.95 ng / ml. (P = 0.679) UFH group and the the LMWH group of CK-MB results were normal before surgery (lt; 5 ng / ml). Postoperative UFH group CK-MB positive 31 cases (57.40%), the LMWH group CK-MB positive in 23 cases (44.23%), no significant differences between the two groups (P = 0.245). UFH group, CK-MB increased 3 times in 12 cases (22.22%) in the LMWH group CB-MB 3 times in 6 cases (11.54%) increase. Between the two groups and there is no significant difference (P = 0.228) (Table 4, Fig 2). Postoperative UFH group CK-MB the 26.56 ± 62.95ng/ml the LMWH group the 8.98 ± 13.62ng / m (lP = 0.030). Results are normal preoperative UFH group and the the LMWH group of MYO (lt; 70ng/ml). Postoperative UFH group MYO positive cases (1.85%), the LMWH group positive in 2 cases (3.84%), no significant difference (P = 0.974) between the two groups. Conclusion: In elective PCI, low molecular weight heparin - dalteparin at least have the same safety and unfractionated heparin; worthy of further study, confirmed in large-scale clinical studies.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Coronary arteries ( atherosclerosis ),heart disease (CHD)
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