Heparin monotherapy for percutaneous coronary intervention?

摘要

The efficacy and safety of percutaneous coronary intervention (PCI) has been substantially enhanced by refinements in antithrombotic treatments. Ischaemic complications were reduced by as much as 50% with addition of platelet glycoprotein IIb/IIIa inhibitors (GPIs) to early regimens of aspirin and heparin.1'2 However, use of these potent platelet inhibitors was accompanied by increased risk of haemorrhagic complications, which are associated with increased mortality, morbidity, and costs.3-4 Development of antithrombotic drugs therefore focused on reducing risks of haemorrhagic events while maintaining protection against ischaemic complications. In several trials in patients undergoing PCI, substitution of the direct thrombin inhibitor bivalirudin for the combination of heparin and a GPI consistently reduced the incidence of major bleeding by about 40%.