有华法林应用指征的患者行冠脉介入术后的抗栓治疗

Analysis of antithrombotic therapy for patients on oral warfarin treatment after PCI

目的 研究有华法林应用指征的患者行冠脉介入手术（PCI）后采用华法林、阿司匹林、氯吡格雷三联抗栓和华法林、氯吡格雷双联抗栓治疗方案的有效性和安全性.方法 回顾性入选2006-2011年期间我院75名有明确华法林应用指征的PCI术后患者.根据患者的用药方案,分为三联抗栓组（TA）：华法林＋阿司匹林＋氯吡格雷,双联抗栓组（DA）：氯吡格雷＋华法林.出院后对患者的用药情况、临床终点事件及安全性进行12个月随访.结果 TA组患者51人,DA组患者24人.在12个月随访期间,TA组中有2例患者死亡,DA组没有死亡病例,两组死亡率比较差异无统计学意义（P=0.332）.安全性方面,两组都没有严重出血病例,TA组有9例患者发生小出血,DA组患者没有发生小出血,两组比较差异有统计学意义（P=-0.028）.结论 有华法林应用指征的患者需要根据患者的情况制订个体化治疗方案.对于老年、既往有出血病史的患者,氯吡格雷联合华法林的双联抗栓治疗策略同样有效,且安全性更高.

Objective To compare the effect and safety of triple antithrombotic therapy including as- pirin, clopidogrel and warfarin to dual antithrombotic therapy with clopidogrel and warfarin for patients after percutaneous coronary intervention （PCI）. Methods 75 patients on long-term oral warfarin treatment after PCI were retrospectively investigated during 2006 to 2011. They were divided into two groups, triple an- tithrombotic therapy group （TA） were treated with aspirin, clopidogrel and warfarin. Dual antithrombotic thera- py group （DA） were treated with clopidogrel and warfarin. All patients were followed-up by at least 12 months after PCI. Incidences of reinfarction, all-cause-death, bleeding adverse events were collected. Results There were 51 patients in TA group and 24 patients in DA group. During the 12 months follow-up, 2 pa- tients died in TA group and no death in DA group （P=0.332）. According to bleeding adverse events, no ma- jor bleeding events happened in both group. 9 patients in TA group reported minor bleeding and none in DA group （P=0.028）. Conclusion Individual strategy was important for patients on long-term oral warfarin treat- ment after PCI. Based on our study, dual antithrombotic therapy with clopidogrel and warfarin was effect and safe as well.