心房颤动合并急性冠状动脉综合征患者抗栓治疗的效果分析

Effect of anticoagulant therapy regimen for patients with atrial fibrillation complicated with acute coronary syndrome undergoing coronary stent implantation

目的探讨心房颤动合并急性冠状动脉综合征患者不同抗栓治疗的效果。方法本研究为回顾性队列研究。选择济南市槐荫人民医院自2014年1月至2017年1月收治的支架治疗的心房颤动合并急性冠脉综合征患者的临床资料,根据抗栓治疗方案将患者分为两组:三联抗栓组(华法林+阿司匹林+氯吡格雷,简称TT组)和二联抗栓组(华法林+氯吡格雷,简称WC组)。随访12个月,评估两组患者抗栓治疗的安全性(出血风险)和有效性(不良心脑血管事件)。结果最终212例患者入选本研究。其中,男性113例,平均年龄为(56. 1±12. 4)岁。TT组139例,WC组73例。两组的抗栓治疗时间、血栓风险、出血风险、支架种类和术后24 h CK-MB峰值均无明显差异(均为P> 0. 05)。平均随访(12. 3±1. 2)个月后发现,TT组的总出血发生率显著高于WC组(P <0. 05)。但两组间的缺血性脑卒中和主要不良心脑血管事件发生率均无显著差异(均为P> 0. 05)。结论心房颤动合并急性冠状动脉综合征患者支架治疗后联合应用华法林和氯吡格雷抗栓治疗较联用华法林、阿司匹林和氯吡格雷三联治疗有效性相似,安全性增加,总出血风险降低。

Objective To evaluate the effect of different anticoagulant therapy regimens in patients with atrial fibrillation complicated with acute coronary syndrome undergoing stent implantation. Methods This was a retrospective cohort study. Patients with acute coronary syndrome and atrial fibrillation undergoing PCI in our hospital from January 2014 to January 2017 were selected. Based on the anticoagulant regimen, all patients were divided into two groups: triple anticoagulant group (treated with warfarin, aspirin and clopidogrel, as TT group) and dual anticoagulant group (treated with warfarin and clopidogrel, as WC group). We compared the safety (risk of major bleeding) and efficacy (major adverse cardiac and cerebrovascular event, MACCE) between the two groups after 12-month follow-up. Results Overall, 212 patients were enrolled in the study, with 113 males, the average age of (56.1±12.4) years. There were 139 patients in the TT group, and 73 patients in the WC group. There was no significant difference in anticoagulant duration, thrombotic risk, bleeding risk, stent types and peak value of CK-MB 24 h post-PCI (all P>0.05). After follow-up of (12.3±1.2) months, the incidence of bleeding in the TT group were significantly higher than that in the WC group ( P<0.05). There was no significant difference in the incidence of MACCE between the two groups ( P>0.05). Conclusions For patients with acute coronary syndrome and atrial fibrillation undergoing stent implantation, dual anticoagulant therapy with warfarin and clopidogrel is a safe and effective anticoagulant regimen, with decreased risk of bleeding and comparable rate of adverse cardiac and cerebrovascular event.