心房颤动合并冠状动脉粥样硬化性心脏病患者PCI治疗后双联抗栓治疗方案的疗效及安全性

Clinical Study of Dual Antithrombotic Therapy in Patients with Atrial Fibrilla⁃tion and Coronary Atherosclerotic Heart Disease after PCI

目的探讨心房颤动合并冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后不同双联抗栓治疗方案的疗效及安全性。方法回顾性分析沧州市人民医院2019年7月至2022年6月收治的167例心房颤动合并冠心病患者的临床资料。按不同双联抗栓治疗方法将167例患者分为A、B、C 3组。A组56例,采用利伐沙班+氯吡格雷;B组56例,采用达比加群酯+氯吡格雷;C组55例,采用华法林+氯吡格雷。比较3组患者栓塞复合事件、出血事件、凝血指标及不良反应。结果A组血栓栓塞复合事件总发生率为14.29%,B组为16.07%,C组为32.73%;A、B组血栓栓塞复合事件总发生率明显低于C组,差异有统计学意义(P<0.05)。A组出血事件总发生率为8.93%,B组为12.50%,C组为25.45%;A、B组出血事件总发生率明显低于C组,差异有统计学意义(P<0.05)。3组治疗后凝血酶原时间(prothrombin time,PT)、国际标准化比值(international normalized ratio,INR)、凝血酶时间(thrombin time,TT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)均较治疗前明显增高,差异有统计学意义(P<0.05);但3组治疗后PT、TT、APTT、INR比较,差异无统计学意义(P>0.05)。3组消化不良、恶心、呼吸困难、头痛及眩晕等不良反应发生率比较,差异无统计学意义(P>0.05),但C组皮疹发生率明显高于A、B两组,差异有统计学意义(P<0.05)。结论在抗血小板药物选择氯吡格雷的基础上,联合利伐沙班或达比加群酯可更有效预防心房颤动合并冠心病患者血栓事件的发生,且安全性相对更高、出血事件发生风险相对更低。

Objectives To investigate the efficacy and safety of different dual antithrombotic therapies in patients with atrial fibrillation and coronary atherosclerotic heart disease after percutaneous coronary intervention(PCI).Methods The clinical data of 167 patients with atrial fibrillation complicated with coronary heart disease in People's Hospital of Cangzhou City from July 2019 to June 2022 were retrospectively analyzed.The 167 patients were divided into A group,B group and C group according to different dual antithrombotic therapies.Fifty-six cases in A group were treated with sevaroxaban and clopidogrel;56 patients in B group were treated with cedabigatran axetil and clopidogrel;55 cases in C group were treated with warfarin and clopidogrel.The combined embolic events,bleeding events,coagulation indexes and adverse reactions were compared among the three groups.Results The total incidence of thromboembolic complica‐tions was 14.29%in A group,16.07%in B group and 32.73%in C group.The total incidence of thromboembolic events in A and B group was significantly lower than that in C group(P<0.05).The total incidence of bleeding events was 8.93%in A group,12.50%in B group and 25.45%in C group.The total incidence of bleeding events in A and B group was significantly lower than that in C group(P<0.05).The coagulation indexes prothrombin time(PT),international normalized ratio(INR),thrombin time(TT)and activated partial thromboplastin time(APTT)in the three groups after treatment were significantly higher than those before treatment(P<0.05).However,there were no significant differencies in PT,TT,APTT and INR among the three groups after treatment(P>0.05).There were no significant differencies in the incidences of adverse reactions such as dyspepsia,nausea,dyspnea,headache and dizziness among the three groups,but the incidence of rash in C group was significantly higher than that in A and B groups(P<0.05).Conclusions On the basis of choosing clopidogrel as antiplatelet drug,combined with rivaroxaban or dabigatrenate can effectively prevent the occurrence of thrombotic events in patients with atrial fibrillation and coronary heart disease,with relatively higher safety and relatively lower risk of bleeding events.