行经皮冠状动脉介入治疗术患者合并心房颤动时抗凝的研究

The cross-section study of anti-coagulation in patients undergone percutaneous coronary intervention combining with atrial fibrillation

目的探讨经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)合并心房颤动患者使用华法林抗凝治疗策略选择。方法选取海军总医院等北京市12家医院2010年1月1日-2014年12月31日行PCI合并心房颤动的患者211例。将患者分成单独抗血小板(阿司匹林或氯吡格雷)+华法林抗凝二联用药组(n=70)和双联抗血小板(阿司匹林+氯吡格雷)+华法林抗凝(n=141)三联用药组2组。随访至2016年4月31日,比较2组主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular events,MACCE)和出血事件的发生情况。结果与二联用药组相比,三联用药组MACCE发生率更高(x^2=7.239,P=0.007),2组出血发生情况结果差异无统计学意义(x^2=1.155,P=0.283)。结论阿司匹林+氯比格雷+华法林抗凝治疗会显著增加MACCE的发生危险,而不会显著增加出血风险。

Objective To analyze the anti-coagulation strategy of using warfarin in patients undergone percutaneous coronary intervention(PCI) combining with atrial fibrillation(AF).Methods Two hundred and eleven cases undergone PCI with AF were collected in 12 hospitals in Beijing including Navy General Hospital from Jan 1,2010 to Dec 31,2014.The cases were divided into 2 groups:single anti-platelet(aspirin or clopidogrel) and warfarin 2 drugs group(n = 70),dual antiplatelet(aspirin and clopidogrel) and warfarin 3 drugs group(n= 141).All cases were followed-up to Apr 31,2016 for comparing the occurrence rate of major adverse cardiovascular and cerebrovascular events(MACCE),and bleeding events in different groups.Results Compared with 2 drugs group,the cases in 3 drugs group had higher rate of MACCE(x^2 = 7.239,P = 0.007).The occurrence rate of bleeding events was not statistically significant between the 2 groups(x^2 = 1.155,P = 0.283).Conclusion Three drugs group could observably increase the occurrence rate of MACCE,but could not significantly augment bleeding risk.