利伐沙班联合氯吡格雷对房颤合并冠心病行经皮冠脉介入术患者的疗效观察

Effect of Rivaroxaban Combined with Clopidogrel in Patients with Atrial Fibrillation and Coronary Heart Disease Undergoing Percutaneous Coronary Intervention

目的:观察利伐沙班联合氯吡格雷对房颤合并冠心病行经皮冠脉介入术患者的疗效和安全性。方法:95例非瓣膜性房颤合并冠心病行经皮冠状动脉介入治疗(PCI,置入均为药物洗脱支架)患者随机分为对照组(48例)和观察组(47例)。两组患者PCI术后予基础治疗。同时对照组给予华法林+氯吡格雷治疗,观察组给予利伐沙班+氯吡格雷治疗,均连续治疗12个月。对比两组患者基线资料;随访2年,评估患者安全性指标(口腔、消化道、呼吸系统、泌尿系统、皮肤等部位的出血风险)和有效性指标(指不良心脑血管事件,包括全因死亡、心源性死亡、心肌梗死、支架内血栓、缺血性卒中等)。结果:观察组TIMI、GUSTO出血事件发生率显著低于对照组(P<0.05)。两组死亡、心肌梗死、靶血管血运重建、缺血性脑卒中发生率差异无统计学意义(P>0.05)。结论:利伐沙班联合氯吡格雷治疗房颤合并冠心病PCI术后的抗凝效果良好,且出血风险较低。

Objective: To study the efficacy and safety of rivaroxaban combined with clopidogrel in patients with atrial fibrillation complicated with coronary artery disease undergoing percutaneous coronary intervention. Methods: Totally 95 patients with non-valvular atrial fibrillation complicated with coronary heart disease undergoing percutaneous coronary intervention( PCI,all with drug-eluting stents) were randomly divided into the control group( 48 cases) and the observation group( 47 cases). The patients in the two groups were treated with PCI. At the same time,the patients in the control group were treated with warfarin+clopidogrel,while the patients in the observation group were treated with rivaroxaban+clopidogrel,and the treatment course was 12 months.The baseline data of the two groups were compared. During 2 years of follow-up,the patient’s safety indicators( risk of bleeding in mouth,digestive tract,respiratory system,urinary system and skin,etc.) and effectiveness indicators( adverse cardio-cerebrovascular events including all-cause death,cardiogenic death,myocardial infarction,stent internal thrombosis and ischemic stroke,etc.) were evaluated. Results: The incidence of TIMI and GUSTO bleeding events in the observation group was significantly lower than that in the control group( P<0.05).There were no significant differences in the incidences of death,myocardial infarction,target vessel revascularization and ischemic stroke between the two groups( P>0.05). Conclusion: Rivaroxaban combined with clopidogrel has a good anticoagulant effect in patients with atrial fibrillation and coronary heart disease after PCI,and the risk of bleeding is low.