老年急性非ST段抬高心肌梗死合并心房颤动患者不同抗栓治疗方案对比研究  

Effects of different antithrombotic therapies for elderly acute non-ST elevation myocardial infarction patients with atrial fibrillation

作　　者：齐静[1] 姜钧文[1] 陈韦[1] 王艳春[1] 李蒙[1] 于乐[1] 周鑫[1] 杜丹[1] 侯平[1] 

机构地区：[1]辽宁中医药大学附属医院心内二科,沈阳110032

出　　处：《中华老年心脑血管病杂志》2014年第3期248-251,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：辽宁省科技厅项目(2012020108-211)

摘　　要：目的 探讨老年急性非ST段抬高心肌梗死（NSTEMI）合并心房颤动（房颤）患者采取不同抗栓策略的有效性和安全性.方法 选取NSTEMI合并永久性房颤的老年患者129例,出院后给予不同的抗栓策略分为4组,A组41例：阿司匹林（100 mg/d）＋氯吡格雷（75 mg/d）,B组31例：华法林（国际标准化比值2.0～2.5）,C组35例：华法林（国际标准化比值2.0～2.5）＋阿司匹林（100 mg/d）/氯吡格雷（75 mg/d）,D组22例：华法林（国际标准化比值2.0～2.5）＋阿司匹林（100 mg/d）＋氯吡格雷（75 mg/d）,对出血和主要心脏复合终点（死亡,再发心肌梗死、脑栓塞）随访1年,行多变量Cox回归分析.结果 A组、B组、C组、D组病死率分别为12.2％、16.1％、14.3％、9.1％.观察1年,8.5％因出血再次入院,20.2％因主要心脏事件再次入院,各组出血及主要心脏事件无统计学差异,但与B组比较,D组出血风险最高（HR=1.267,95％CI：0.340～4.718,P=0.25）.C组有低风险趋势（HR=0.911,95％CI：0.319～2.597,P=0.37）.结论 随着抗栓力度的增强,阿司匹林十氯吡格雷十华法林相对出血的风险加大,华法林联合一种抗血小板药物对于主要心脏复合终点有降低的趋势.Objective To study the efficiency and safety of different antithrombotic therapies for elderly acute NSTEMI patients with atrial fibrillation.Methods One hundred and twenty-nine NSTEMI patients were divided into group A （n=41）,group B （n=31）,group C （n=35） and group D （n=22）.Patients in group A were treated with aspirin （100 mg/d）＋ clopidogrel （75 mg/ d）,patients in group B were treated with warfarin （INR 2.0-2.5）,patients in group C were treated with warfarin （INR 2.0-2.5）＋aspirin（100 mg/d）/clopidogrel （75 mg/d）,patients in group D were treated with warfarin （INR 2.0-2.5）＋aspirin （100 mg/d）＋clopidogrel （75 mg/d）.Patients with bleeding,major cardiac events were followed up for 1 year and analyzed by multivariate Cox regression analysis.Results The mortality was 12.2 %,16.1%,14.3%,9.1% in groups AD.Of the patients who were followed up for 1 year,8.5 % were admitted to our hospital again for bleeding,and 20.2 % were admitted to our hospital again for major cardiac events.No significant difference was found in bleeding and major cardiac events among the 4 gropups although the risk of bleeding was higher in group D than in group B and group C （HR=1.267,95%CI：0.340-4.718,P=0.25;HR=0.911,95%CI：0.319-2.597,P=0.37）.Conclusion Aspirin＋clopidogrel＋ warfarin increases the risk of bleeding with the increased antithrombotic intensity.Warfarin in combination with aspirin or clopidogrelcan decreases the risk of major cardiac events.

关 键 词：心肌梗死 心房颤动 阿司匹林 华法林 

分 类 号：R542.22[医药卫生—心血管疾病] R541.75[医药卫生—内科学]