心房颤动患者冠脉PCI术后达比加群酯联合氯吡格雷抗栓治疗的疗效及安全性评价

Antithrombotic effect and safety of Dabigatran combined with Clopidogrel in patients with atrial fibrillation after undergoing percutaneous coronary intervention

目的探讨心房颤动患者经皮冠状动脉介入治疗术(PCI)支架植入后,采用达比加群酯联合氯吡格雷抗栓治疗的疗效及安全性。方法选取冠心病患者合并心房颤动行PCI术患者85例,随机分为达比加群组(n=42)和对照组(n=43)。术后达比加群组给予达比加群酯联合氯吡格雷抗栓治疗,对照组给予华法林联合氯吡格雷抗栓治疗。治疗后随访12个月,观察比较两组患者服药前后凝血指标的变化、出血事件(颅内出血或临床可见出血)及不良心血管事件(急性心肌再梗死、缺血诱导的靶血管血运重建治疗、心源性猝死、缺血性脑卒中、短暂性脑缺血发作)发生情况。结果服药前后达比加群组凝血酶时间(TT)、活化部分凝血活酶时间(APTT)相比差异均具有统计学意义(t=4.65、5.86,P<0.05),对照组凝血酶原时间(PT)、国际化标准比值(INR)、TT、APTT相比差异均具有统计学意义(t=5.30、5.56、5.05、4.68,P<0.05)。达比加群组与对照组不良心血管事件的发生率比较,差异无统计学意义(χ2=2.20,P>0.05),而总出血事件、严重出血事件发生率下降,差异具有统计学意义(χ2=4.78、5.06,P<0.05)。结论与华法林联合氯吡格雷相比,达比加群酯联合氯吡格雷抗栓治疗冠心病合并心房颤动患者抗栓疗效相似,而出血发生率低,安全性更强。

Objective To evaluate the antithrombotic effect and safety of Dabigatran combined with Clopidogrel in patients with atrial fibrillation after percutaneous coronary intervention.Methods85patients with atrial fibrillation and coronary heart disease who underwent PCI surgery were randomly divided into dabigatran treatment group(observation group,n=42)and warfarin group(control group,n=43).The observation group was given dabigatran combined with clopidogrel,while the control group was given warfarin combined with clopidogrel.These patients were followed up for12months.Blood coagulation indexes,occurrence of bleeding events(intracranial hemorrhage or clinical visible bleeding)and adverse cardiovascular events(recurrence of myocardial infarction,target vessel revascularization,cardiac ischemic death,ischemic stroke,transient ischemic attack)were observed and compared between the two groups.Results After treatment,APTT and TT in the observation group were significantly higher than that before the treatment(t=4.65,5.86,P<0.05).While in the control group,PT,INR,TT and APTT levels in the control group were significantly different from those levels before the treatment(t=5.30,5.56,5.05,4.68,P<0.05).There was no significant difference in incidence of adverse cardiovascular events between the two groups(χ2=2.20,P>0.05),but the total and serious number of cases with occurrence of bleeding events of the observation group were significant lower than the control group(χ2=4.78,5.06,P<0.05).Conclusion With advantages of lower incidence of bleeding and better safety,clopidogrel combined with dabigatran shows equivalent antithrombotic effect to warfarin combining with clopidogrel.