房颤合并冠脉支架术后的抗栓策略及出血风险评估

Antithrombotic strategy and bleeding risk assessment after atrial fibrillation combined with coronary stenting

房颤合并冠心病支架术后的患者需要抗血小板和抗凝的双重抗栓治疗,但出血风险高。如何平衡血栓与出血风险,选择合适的抗栓策略是目前的临床难题及研究热点。以华法林或新型口服抗凝药为基础的三联或双联抗血小板和抗凝的双重抗栓治疗应用越来越广泛,出血风险逐渐增加,因此建立有效的出血预测模型筛选出血高危人群有助于做出临床决策规避风险。本文就对房颤合并冠脉支架术后抗栓治疗的抗栓策略及现有出血评分系统做一综述。

One of the major complications of atrial fibrillation is thromboembolic disease,and there is a risk of stent thrombosis after coronary stenting.Therefore,patients with atrial fibrillation complicated with coronary artery disease require antiplatelet and anticoagulation dual antithrombotic treatment,but the risk of bleeding is high.How to balance the risk of thrombosis and bleeding,the selection of appropriate anti-thrombotic strategy is the current clinical problem and research hotspot.With the advancement of coronary interventional techniques,the number of patients with atrial fibrillation complicated with coronary stenting has gradually increased,and triple or dual antiplatelet and anticoagulant of dual antithrombotic therapy based on warfarin or new oral anticoagulant the application is more and more extensive,and the bleeding risk is gradually increased.Establishing an effective bleeding prediction model to screen high-risk populations of bleeding helps to make clinical decision-making avoidance risks.This article reviews the current advantages and limitations of drug selection,drug combination,domestic and international guidelines and expert consensus recommendations for atrial fibrillation combined with coronary stenting and various bleeding scoring systems.