房颤合并肝硬化患者的口服抗凝药物选择及抗栓策略研究

Choice of Oral Anticoagulant Drug and the Antithrombotic Strategy in Patient with Atrial Fibrillation and Cirrhosis

目的探讨房颤合并肝硬化患者临床治疗中口服抗凝药物的选择及安全性。方法在1例房颤合并乙型肝炎肝硬化患者房间隔修补术后抗栓方案的制定中,通过查阅指南和文献,总结、分析房颤合并肝硬化患者口服抗凝药物的疗效及安全性评价现状。结果通过综合评估患者情况,停用华法林,予达比加群酯110 mg,bid,联合氯吡格雷75 mg,qd抗栓6个月,之后达比加群酯110mg,bid长期抗凝治疗。结论房颤合并肝硬化患者抗栓治疗,应充分评估血栓及出血风险,制定个体化的抗栓策略。房颤合并Child-Pugh A级肝硬化,新型口服抗凝药均可使用;合并Child-Pugh C级肝硬化,口服抗凝剂均不建议使用;合并Child-Pugh B级肝硬化,出血风险高的患者长期抗凝治疗中可选用小剂量达比加群酯。

OBJECTIVE To investigate the choice and safety of oral anticoagulation drugs in the treatment of patients with atrial fibrillation combined cirrhosis. METHODS By formulating the antithrombosis therapy plan for a patient after atrioseptopexy with atrial fibrillation and hepatitis B cirrhosis, the efficacy and status of safety evaluation of oral anticoagulation in treatment of atrial fibrillation combined cirrhosis according to the guidelines and literatures summarized and analyzed. RESULTS By comprehensive assessment of patient＇s situation, warfarin was discontinued, dabigatran 110 mg, bid combined with clopidogrel 75 mg, qd were used for 6 months, followed by dabigatran 110 mg, bid in long term anticoagulant therapy was adopted. CONCLUSION Thrombosis and bleeding shall be fully concerned in patient with atrial fibrillation and cirrhosis, and of individual antithrombotic therapy strategy will be developed accordingly. Atrial fibrillation and Child-Pugh A cirrhosis, new oral anticoagulants can be used; Child-Pugh C cirrhosis, oral anticoagulants are not recommended; Child-Pugh B cirrhosis with high risk of bleeding, a small dose of dabigatran etexilate can be used in long-term anticoagulation.