华法林与阿司匹林和氯吡格雷三重抗栓治疗的安全性

The safety of combined warfarin,aspirin and clopidogrel triple antithrombotic therapy.

目的观察有华法林抗栓指征的患者,冠状动脉(简称冠脉)支架植入术后,联合华法林、阿司匹林和氯吡格雷三重抗栓治疗的安全性。方法选择23例心房颤动(有1项以上危险因素)、机械瓣置换术后和左室血栓的患者,冠脉植入药物洗脱支架后,联合华法林、阿司匹林和氯吡格雷(三重抗栓组)治疗,严格控制国际标准化比值(INR)1.6～2.5,观察1年总的和严重出血事件的发生率。分别选择同期86例冠心病患者,植入冠脉支架后应用阿司匹林和氯吡格雷(双重抗血小板组)治疗,64例有华法林抗凝指征的患者,应用华法林抗凝(抗凝组)治疗(INR2.0～3.0)进行比较。结果三重抗栓组1年总的出血发生率为17.4%,与双重抗血小板组(4.7%)比较有显著性差异(P<0.05),而与抗凝组(10.9%)比较差异无显著性。严重出血事件三重抗栓组显著高于其他两者(13.3%vs 1.2%,4.7%,P<0.01或0.05)。结论三重抗栓治疗明显增加患者出血的发生率。

Objective To observe the safety of combined warfarin, aspirin and clopidogrel triple antithrombus therapy in patients after the coronary artery stent implantation with indications of warfarin anticoagulant. Methods Twtenty-three patients with atrial fibrillation （with one or more risk factors）, mechanical valve replacement and left ventricular thrombus were given the combined warfarin, aspirin and clopidogrel （triple antithrombotic group） treatment after coronary drug-elu- ting stents implanted. To strictly control international normalized ratio （ INR）, and to observe the total hemorrhage inci- dence and severe hemorrhage incidence in one year. 86 cases with coronary heart disease and 64 cases with indications for warfarin anticoagulation were selected as control group in the same period. 86 were given aspirin and clopidogrel （ dual anti- platelet group） therapy after coronary stent implantation. 64 cases were given warfarin anticoagulant （anticoagulant group） therapy. Results The total hemorrhage incidence in triple antithrombotic group was 17.4% in one year. Compared with dual antiplatelet group（4.7% ） there was a significant difference（ P 〈 O. 05 ）, but no significant difference with the antico- agulant group（ 10.9% ）. Severe hemorrhage cases in antithrombotic group were significantly higher than that of other two groups（ 13.3% vs 1.2% ,4.7% ,P 〈0.01 or 0.05）. Conclusion Triple antithrombotic therapy significantly increases the incidence of hemorrhage in patients.