房颤合并冠心病患者冠脉支架植入术后不同抗凝方法比较

Comparison of different anticoagulation methods after intracoronary stent implantation for patients with AF complicated with coronary heart disease

目的对比分析心房颤动合并冠心病患者冠脉支架植入术后三联与二联抗凝的疗效及安全性。方法收集医院收治的86例行冠脉支架置入术的心房颤动合并冠心病患者,分为观察组及对照组各43例,观察组给予三联抗凝治疗(华法林+阿司匹林+氯吡格雷),对照组给予二联抗凝治疗(阿司匹林+氯吡格雷)。比较两组抗凝治疗前后检测指标变化、治疗有效性以及安全性。结果治疗前,两组PLT、CRP、D-D及FIB均无统计学差异(P>0.05);治疗后,两组各指标均得到恢复,观察组改变幅度显著高于对照组(P<0.05)。观察组出血事件发生率为16.28%,对照组为6.98%,观察组略高于对照组,但差异无统计学意义(P>0.05)。观察组心血管不良事件发生率为6.98%,对照组为23.26%,观察组明显低于对照组(P<0.05)。结论对房颤合并冠心病患者冠脉支架植入术后,使用三联抗凝治疗疗效及安全性较好,但会增加出血风险,应结合患者自身情况选择个体化抗凝方案。

Objective To compare the effects and safety of triple and double anticoagulation after intracoronary stent implantation for patients with atrial fibrillation （AF） complicated with coronary heart disease. Methyls A total of 86 patients with AF complicated with coronary heart disease to receive coronary stent implantation in our hospital were selected and randomly divided into an observation group and a control group（n=43, respectively）. The observation group was treated with triple anticoagulation （warfarin ＋ aspirin ＋ clopidogrel） and the control group was treated with double anticoagulation （aspirin ＋ clopidogrel）. The changes of detection indexes before and after the treatment as well as the effects and safety between the two groups were compared.Results Before the treatment, there was no significant difference in PLT, CRP, D-D and FIB between the two groups （P 〉 0.05）; after the treatment, all indexes in the two groups were restored and the change range in the observation group was significantly greater than that in the control group （P 〈 0.05）. The incidence of bleeding was 16.28% in the observation group, slightly higher than that in the control group （6.98%）, but the difference had no statistical significance （P 〉 0.05）. The incidence of adverse cardiovascular events was 6.98% in the observation group, significantly lower than that in the control group （23.26%; P 〈 0.05）.Conclusion The application of triple anticoagulation for patients with atrial fibrillation （AF） complicated with coronary heart disease after intracoronary stent implantation has good effects and high safety, but may increase the risk of bleeding. Therefore, individualized anticoagnlation regimen should be selected in combination with the patient＇s conditions.