非瓣膜性心房颤动患者PCI术后双联抗栓治疗最新进展

Recent advances in dual antithrombotic therapy after PCI in patients with non-valvular atrial fibrillation

大约有10%的非瓣膜性心房颤动(NVAF)患者接受经皮冠状动脉介入治疗(PCI)。该类患者栓塞事件发生率很高,需要抗凝联合抗血小板治疗。临床上NVAF患者PCI术后通常采用口服抗凝药(OAC)+阿司匹林+氯吡格雷三联抗栓治疗(TAT)。TAT虽然能有效预防栓塞事件发生,但存在高出血风险。研究显示新型口服抗凝药(NOACs)联合氯吡格雷双联抗栓治疗(DAT)抗栓疗效不劣于TAT,且出血风险明显降低。尽管如此,目前指南对于NVAF患者PCI术后抗栓治疗仍存在部分争议。本文就NVAF患者PCI术后DAT与TAT的安全性及有效性进行综述,以指导临床上该类患者合理选择抗栓策略。

About 10% of patients with non-valvular atrial fibrillation(NVAF) underwent percutaneous coronary intervention(PCI).The incidence of embolic events in these patients is high and requires anticoagulation combined with antiplatelet therapy.Clinically,patients with NVAF usually receive oral anticoagulant(OAC) + aspirin + clopidogrel triple antithrombotic therapy(TAT) after PCI.Although TAT can effectively prevent embolic events,there is a high risk of bleeding.Studies have shown that new oral anticoagulants(NOACs) combined with clopidogrel dual antithrombotic therapy(DAT) anti-thrombotic effect is not inferior to TAT,and the risk of bleeding is significantly reduced.Despite this,the current guidelines are still controversial for antithrombotic therapy after PCI in patients with NVAF.This article reviews the safety and efficacy of DAT and TAT in patients with NVAF after PCI to guide the rational selection of antithrombotic strategies in these patients.