达比加群酯与华法林用于冠心病合并心房颤动中的效果及安全性比较

Comparison of the efficacy and safety of dabigatran etexilate and warfarin in the treatment of coronary heart disease complicated with atrial fibrillation

目的比较达比加群酯与华法林在冠心病合并心房颤动治疗中的临床效果及其安全性。方法选取2018年4月~2019年4月我院收治的冠心病合并心房颤动患者82例进行研究,根据治疗方案不同进行分组,A组(n=41)采用氯吡格雷联合达比加群酯治疗,B组(n=41)采用氯吡格雷联合华法林治疗,比较两组治疗效果、心脑血管不良事件发生率及出血事件发生情况。结果A组治疗总有效率为95.12%,与B组的92.68%比较,差异无统计学意义(P>0.05)。两组患者治疗后的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)检测值显著优于治疗前,但组间差异无统计学意义(P>0.05)。随访1年,两组患者的血运再次重建、急性心肌梗死、短暂性脑缺血发作、缺血性脑卒中等血栓栓塞事件总发生率比较,差异无统计学意义(P>0.05)。但A组出血事件总发生率为7.32%,较B组的24.39%明显降低(P<0.05)。结论达比加群酯与华法林在冠心病合并心房颤动治疗中的抗凝效果相当,能够有效减少心脑血管不良事件发生,但达比加群酯的出血风险更低,安全性更高,值得推广应用。

Objective To compare the clinical efficacy and safety of dabigatran etexilate and warfarin in the treatment of coronary heart disease(CHD)complicated with atrial fibrillation(AF).Methods A total of 82 patients with CHD complicated with AH admitted toand treated in our hospital from April 2018 to April 2019 were selected for the research and divided into groups according to different therapeutic schemes.Group A(n=41)was treated with clopidogrel combined with dabigatran etexilate,while Group B(n=41)was treated with clopidogrel combined with warfarin.The therapeutic effect,the incidence of cardiovascular and cerebrovascular adverse events(AEs)and the occurrence of bleeding events were compared between the two groups.Results The total effective rate of treatment in Group A was 95.12%,which showed no statistically significant difference when compared with the 92.68%in Group B(P>0.05).After treatment,the detected values of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB)of the two groups of patients were significantly better than those before treatment,but the differences between the two groups were statistically insignificant(P>0.05).After 1 y of follow-up,there were no statistically significantdifferences between the two groupsof patients in the total incidence of thromboembolic events such as revascularization,acute myocardial infarction,transient ischemic attack and ischemic stroke,etc.(P>0.05).However,the total incidence of bleeding events in Group A was 7.32%,obviously lower than the 24.39%in Group B(P<0.05).Conclusion The anticoagulation effect of dabigatran etexilate in the treatment of CHD complicated with AHis equivalent to that of warfarin.Both can effectively reduce the occurrence of cardiovascular and cerebrovascular AEs.However,dabigatran etexilate has lower risk of hemorrhage and sounder safety,and is worthy of promotion and application.