心房颤动合并经皮冠状动脉介入治疗术后的联合抗栓治疗  

The antithrombotic therapy for patients with atrial fibrillation undergoing percutaneous coronary intervention

作　　者：麦林琳[1] 胡允兆[1] 吴焱贤[1] 欧阳海春[1] 陈盈文[1] 王航鹰[1] 

机构地区：[1]南方医科大学附属顺德第一人民医院心血管内科,广东省佛山市528300

出　　处：《实用医学杂志》2015年第16期2637-2640,共4页The Journal of Practical Medicine

基　　金：广东省省级科技计划项目(编号:2013B021800116)

摘　　要：目的:比较心房颤动合并经皮冠状动脉介入治疗(PCI)术后采用二联抗栓方案(华法林+氯吡格雷)(DT)和3个月的三联抗栓方案(华法林+阿司匹林+氯吡格雷)(TT)+9个月的二联抗栓方案(华法林+氯吡格雷,DT)(TT+DT)的有效性和安全性。方法:入选心房颤动合并PCI术后病例90例,随机分为DT组(45例)和TT+DT组(45例)。DT组采用12个月的二联抗栓方案,TT+DT组采用3个月的三联抗栓+9个月的二联抗栓方案。对两组的有效性及安全性进行随访。结果:有效性随访结果表明:TT+DT组心肌梗死、靶血管血运重建、卒中及支架内血栓形成事件低于DT组(P<0.05)。安全性随访结果表明:TT+DT组出血事件高于DT组,但无统计学差异(P>0.05)。结论:心房颤动合并PCI术后采用TT+DT方案和DT方案在出血事件的安全性方面无显著差异,但TT+DT方案组治疗有效性优于DT方案组。Objective To compare the efficacy and safety of singular double antithrombotie therapy（DT） using warfarin plus clopidogrel and the combined antithrombotie therapy of 3-month triple antithrombotie therapy （TT） using warfarin, aspirinand clopidogrel and 9-month double antithrombotie therapy （DT） for the patients with atrial fibrillation undergoing PCI. Methods Ninety patients with atrial fibrillation undergoing PCI were randomly divided into two groups evenly： one group was treated with dual antithrombotic therapy group （DT） and the other group with the combined therapy, e. g. 3-month triple antithrombotie therapy（TT） and 9-month double antithrombotie therapy （DT ＋ TT for short）. All patients were followed-up by 12 months. The two groups were compared in terms of incidences of death, myocardial infarction, stroke, target-vessel revascularisation, stent thrombosis and bleeding adverse events. Results The incidences of myocardial infarction, stroke, target- vessel revascularisation, stent thrombosis and bleeding adverse events in the TT ＋ DT group were all significantly lower than the DT group （P 〈 0.05）. The follow-up on the safety indicated that the rate of bleeding in the TT ＋ DT group was insignificantly higher than the DT group （P 〉 0.05）. Conclusion There is no significant difference in safety between the two groups. However, the therapy of TT ＋ DT is more effective.

关 键 词：心房颤动 冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 华法林 血小板聚集抑制剂 

分 类 号：R541.75[医药卫生—心血管疾病]