房颤合并冠状动脉粥样硬化性心脏病的抗栓治疗策略

Anticoagulation Strategy in Patients with Atrial Fibrillation and Coronary Artery Disease

房颤和冠状动脉粥样硬化性心脏病均为常见疾病。缺血性卒中和系统性血栓栓塞是房颤患者的主要不良预后,抗栓治疗可显著减少血栓栓塞事件风险;另一方面,抗血小板治疗又是冠状动脉粥样硬化性心脏病治疗的关键。当房颤患者合并冠状动脉粥样硬化性心脏病时,需要通过抗凝联合抗血小板治疗以减少卒中及缺血性心脏事件的发生。然而,联合抗栓策略会增加出血并发症的风险。如何平衡出血和血栓风险,以及如何在不同口服抗凝药物和抗血小板药物中进行选择,制定最优的抗栓方案是临床工作面临的挑战。

Both coronary artery disease and atrial fibrillation are common diseases.Ischemic stroke and systemic embolism are major adverse outcomes of atrial fibrillation,and antithrombotic treatment reduces the risk of thromboembolic events significantly.On the other hand,antiplatelet therapy is essential in patients with coronary artery disease.Combined antiplatelet-anticoagulant therapy is required to reduce the risk of recurrent ischemic cardiac events and stroke in patients with atrial fibrillation coexisting with coronary artery disease.However,this antithrombotic strategy is associated with an increased risk of bleeding complications.It is challenging in clinical practice to balance the risk of bleeding and thromboembolism,and to choose from oral anticoagulants and antiplatelet agents to establish an optimal strategy.