RU2294746C2 - Method for preventing thrombogenesis at carrying out coronary angioplasty and stenting - Google Patents

Abstract

FIELD: medicine, cardiology.

SUBSTANCE: the present innovation deals with preparing patients to operation on coronary angioplasty and stenting coronary arteries. So, before surgical interference at the background of applying aspirin, thienopyridines, heparin, it is necessary to inject additionally intravenously dalargin by drops in 100 ml physiological solution at the arte of about 5-7 mcg/kg/h at daily dosage being 25-30 mcg/kg and 200 ml rheopolyglucin solution. Subsequent introduction of dalargin of rheopolyglucin should be fulfilled once daily for 4-5 d after operation. The innovation enables to increase the level of cardioprotection and decrease the level of thrombogenesis due to multi-component action, antioxidant one, among them, also, the method in question is of high antinociceptive action due to decreasing the activation of hypothalamo-hypophyseo-adrenal system.

EFFECT: higher accuracy and efficiency of prophylaxis.

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Description

The invention relates to medicine, in particular to cardiology, and is a method of preventing thrombosis during coronary angioplasty and stenting (CAS) of coronary arteries.

A known method for the prevention of thrombosis during CAS (S. D. Chernyshev, A. G. Mizin, S. Yu. Pulatova and others. The first experience of angioplasty with stenting of the coronary arteries in patients with coronary heart disease. Circulatory pathology and cardiac surgery 1998, No. 1 , p.51), including the use of ticlopidine 72 hours before the procedure at a dose of 500 mg per day, indirect anticoagulants (phenyline) and heparin for the prevention of thrombosis at a dose of 15,000 units. intravenously directly during CAS.

A known method of preventing thrombosis during CAS (Recommendations of the American Heart Association and the American Cardiology College "Coronary Angioplasty", American College of Cardiology), taken as a prototype, including the use of aspirin 2 hours before the intervention at a dose of 80-325 mg, taking thienopyridines: ticlopidine 72 hours before the procedure at a dose of 500 mg per day with a transition to a maintenance dose of 500 mg per day, clopidogrel in a saturating dose of 300 mg with a transition to maintenance is considered as an alternative to ticlopidine high dose of 75 mg, heparin for the prevention of thrombosis in a dose of 100 units. per 1 kg bolus immediately before CAS and the use of inhibitors of the glycoprotein receptors GP2b / 3a abciximab, eptifibatide, tirofiban in the form of a bolus followed by a 24-hour infusion.

The disadvantages of the known methods are the lack of hemorheological properties, insufficient cardioprotective effect, insufficient prevention of thrombosis during CAS and post-reperfusion syndrome after CAS, one of the components of which is oxidative stress and lipid peroxidation. None of the components of the treatment has antioxidant properties and the ability to increase the stability of cell membranes. None of the components of the treatment has an analgesic effect and does not improve capillary blood flow.

The objective of the invention is to provide a method that allows for the conduct of CAS to increase the level of cardioprotection and reduce the level of thrombosis, as a rule, leading to the development of the phenomenon of lack of renewed blood flow, acute myocardial infarction and less often fatal outcome.

This problem is solved in that according to the method for the prevention of thrombosis during coronary angioplasty and stenting, including the use of aspirin, thienopyridines, heparin immediately before coronary angioplasty and stenting, dalargin is additionally administered intravenously at a rate of 5-7 μg / kg / h at a daily dose of 25 -30 mcg / kg once a day per 100 ml of physiological solution of sodium chloride and a solution of reopoliglyukin 200 ml once a day immediately before coronary angioplasty and stenters Niemi and in the next four - five days.

Using the claimed invention will allow to reduce the level of thrombotic complications, including the development of acute myocardial infarction of complications during CAS and a more pronounced cardioprotective effect during CAS. It was first revealed that the method improves capillary blood flow, prevents the development of the phenomenon of no renewed blood flow (no reflow) after CAS, preventing capillary spasm, thrombosis and distal microembolization, damage and interstitial endothelial edema. The method has a pronounced antioxidant multicomponent effect, which is an additional protection of myocardial cells from ischemia, stabilizes and prevents the destruction of cell membranes. The claimed method has an antinociceptive effect, limits emotional and pain stress and also reduces the activation of the hypothalamic-pituitary-adrenal system. In addition, the claimed invention allows to achieve a higher level of preventability of the development of thrombotic complications during the operation of CAS, including acute myocardial infarction and coronary mortality compared with the treatment regimen taken as a prototype.

The method is implemented as follows: to the patient, in addition to therapy with heparin, ticlopidine, clopidogrel and aspirin, dalargin is injected intravenously at a rate of 5-7 μg / kg / h at a daily dose of 25-30 μg / kg once a day per 100 ml of physiological saline sodium chloride and a solution of reopoliglyukin 200 ml once a day immediately before CAS and in the next four to five days.

Example 1. Patient A., 56 years old. Diagnosis: ischemic heart disease. Operation of CAS of the right coronary artery for coronary sclerosis, stable angina of exertion FC3. Arterial hypertension of the III degree, risk 4. CHF IIa, FC3. After the treatment, including the use of aspirin at a dose of 125 mg per day, taking ticlopidine 72 hours before the procedure at a dose of 500 mg per day, with a transition to a maintenance dose of 500 mg per day, heparin at a dose of 100 units. 1 kg bolus before CAS, the administration of dalargin intravenously once a day at a rate of 7 μg / kg / h at a daily dose of 25 μg / kg per day and the introduction of an intravenous solution of reopoliglyukin 200 ml immediately before CAS and in the next 5 days, is prescribed with improvement : no angina pectoris, CAS without thromboembolic complications.

Example 2. Patient C., 50 years old. Diagnosis: ischemic heart disease. CAS operation of the anterior descending artery for progressive angina with incoming ischemia in the septal apical region of the left ventricle and critical stenosis with parietal thrombosis of the anterior descending artery. CHF I FC3. According to the ECG, acute ischemia along the septal apical region of the left ventricle is received, and blood tests show hypercoagulation. After CAS and treatment, including the use of aspirin at a dose of 125 mg per day, taking ticlopidine 72 hours before the procedure at a dose of 500 mg per day with a transition to a maintenance dose of 500 mg per day, heparin at a dose of 100 units. 1 kg bolus before CAS, the administration of dalargin intravenously once a day at a rate of 7 μg / kg / h at a daily dose of 30 μg / kg per day and the introduction of an intravenous reopoliglukin solution of 200 ml immediately before CAS and in the next 5 days, is prescribed with improvement : CAS without thromboembolic complications, no anginal pain, laboratory parameters returned to normal. According to the ECG, after 2 days of dalargin infusion, acute subendocardial ischemia disappeared.

Claims (1)

A method for the prevention of thrombosis during coronary angioplasty and stenting, including the use of aspirin, thienopyridines, heparin before coronary angioplasty and stenting, characterized in that dalargin is additionally administered intravenously at a rate of 5-7 μg / kg / h, in a daily dose of 25-30 μg / kg in 100 ml of physiological solution of sodium chloride and a solution of reopoliglukin 200 ml 1 time per day before coronary angioplasty and stenting and in the next four to five days after the procedure.