利伐沙班联合替格瑞洛对介入治疗术后老年非瓣膜性心房颤动患者疗效和安全性研究

Efficacy and safety of rivaroxaban combined with ticagrelor for NVAF in elderly patients after percutaneous coronary intervention

目的 探究老年非瓣膜性心房颤动(nonvalvular atrial fibrillation,NVAF)合并急性冠状动脉综合征(acute coronary syndrome,ACS)患者PCI术后,利伐沙班联合替格瑞洛双联抗栓治疗的临床疗效和安全性。方法 选择2018年1月~2021年1月于内蒙古自治区人民医院诊治的ACS合并NVAF行PCI的老年患者108例作为研究对象,随机分为研究组和对照组,每组54例,研究组2例失访,对照组3例失访。最终研究组52例,对照组51例。研究组采用双联抗栓治疗(利伐沙班15mg/d+替格瑞洛90mg/d),对照组采用标准三联抗栓治疗6个月(阿司匹林肠溶片100mg/d+氯吡格雷75mg/d+华法林),7~12个月,给予患者氯吡格雷75mg/d+华法林治疗。治疗时间1年,治疗期间对所有患者进行随访,记录治疗期间患者的血栓栓塞事件及出血事件发生情况。随访1年结束,比较2组患者治疗期间,血栓栓塞事件、出血事件的发生率。结果研究组失访率3.70%;对照组失访率5.56%,2组患者的基本资料比较无显著差异(P>0.05)。研究组与对照组的血栓栓塞事件(缺血性脑卒中、支架内血栓、心肌梗死、外周动脉栓塞、肺栓塞)发生率比较差异无统计学意义(P>0.05);研究组患者的轻微出血发生率显著低于对照组,差异有统计学意义(5.77%vs 19.61%,P=0.034)。结论 利伐沙班联合替格瑞洛双联抗栓治疗ACS合并NVAF行PCI术后的老年患者,临床效果与标准三联抗栓治疗相当,且出血风险低,安全性更高。

Objective To investigate the efficacy and safety of rivaroxaban combined with ticagrelor in the treatment of elderly patients with non-valvular atrial fibrillation(NVAF)complicated with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A total of 108elderly patients with ACS and NVAF who underwent PCI in our hospital from January2018to January 2021were prospectively enrolled in this study.They were randomly divided into the study group and the control group,with 54patients in each group.And there were finally 52cases in the former group and 51in the latter group due to 2and 3cases lost respectively at the end of follow-up.The patients in the study group received dual antithrombotic therapy(rivaroxaban 15mg/d+ticagrelor 90mg/d for 12months),and those from the control group were treated with standard triple antithrombotic therapy(aspirin enteric-coated tablet 100mg/d+clopidogrel tablet 75mg/d+warfarin sodium tablet at an appropriate dose adjusted depending on international normalized ratio of 2.0-2.5for 6months,followed by clopidogrel tablet 75mg/d+warfarin sodium tablet in the next 6months).During the 12-month treatment period,all patients were followed up,and thromboembolic events and bleeding events were recorded.At the end of follow-up,the incidences of thromboembolic events and bleeding events were compared between the 2groups.Results The loss rate was 3.70%in the study group and 5.56%in the control group during follow-up period.There were no significant differences in baseline data between the 2groups(P>0.05).The incidence of thromboembolic events(ischemic stroke,stent thrombosis,myocardial infarction,peripheral artery embolism,pulmonary embolism)in the study group was not significantly different from that in the control group(P>0.05).While,the incidence of minor bleeding was notably lower in the study group than the control group(5.77%vs 19.61%,P=0.034).Conclusion For the elderly patients with ACS and NVAF after PCI,rivaroxaban combined with ticagrelor achieves comparable clinical efficacy to standard triple antithrombotic therapy,and has the advantages of higher safety and lower risk for bleeding.