房颤患者支架介入术后不同抗凝方案效果及出血风险比较  

Effects of Different Anticoagulant Regimens and risk of Bleeding in Patients with Atrial Fibrillation after Stent Implantation

作　　者：黄智力 凌智瑜[1] 殷跃辉[1] HUANG Zhi- li;LING Zhi- yu;YIN Yue- hui(Second Hospital Affiliated to Chongqing Medical University, Chongqing,Yuzhong District,400000, Chin)

机构地区：[1]重庆医科大学附属第二医院,重庆400000

出　　处：《血栓与止血学》2018年第3期370-373,376,共5页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的比较房颤(AF)患者药物洗脱支架介入后不同抗凝方案治疗的出血风险以及心脑血管事件发生风险。方法选取本院2012年1月至2015年1月期间收治的行药物洗脱支架介入术AF患者161例为研究对象,根据患者医生的推荐和患者家家属的意愿分为三联抗栓组(TT组)、双联抗栓组(DT组)、华法林联合氯吡格雷组(W+C组)和利伐沙班组(R组)。TT组采用华法林、阿司匹林联合氯吡格雷三联抗栓治疗,DT组采用阿司匹林、氯吡格雷双联抗栓治疗,W+C组采用华法林、氯吡格雷治疗,R组采用利伐沙班治疗。门诊或电话随访2年,统计患者出血事件、主要心脑血管事件发生率以及INR达标率。结果 TT组出血事件总发生率为16.00%,显著高于DT组、W+C组和R组(P<0.05),DT组、W+C组和R组出血事件总发生率之间差异无统计学意义(P>0.05);TT组主要心脑血管事件总发生率为6.00%,R组主要心脑血管事件总发生率为5.71%,显著低于DT组(P<0.05),TT组、R组和W+C组主要心脑血管事件总发生率之间差异无统计学意义(P>0.05),DT组和W+C组主要心脑血管事件总发生率之间差异无统计学意义(P>0.05);TT组每月INR达标率低于W+C组,但差异无统计学意义(P>0.05)。结论 AF患者药物洗脱支架介入后采用三联抗栓治疗可显著减少脑卒中、心肌梗死等主要心脑血管事件发生率,但出血风险相对较大;双联抗栓治疗和华法林、氯吡格雷联合治疗虽降低出血风险,但心脑血管事件发生率较高,利伐沙班治疗不仅可减少出血事件,还可减少心脑血管事件。Objective To compare the risks of bleeding and cardiovascular events m patients wlm atrial fibrillation（AF） treated by different anticoagulant regimens after drug-eluting stents intervened. Methods A total of 126 patients with AF who underwent drug-eluting stents intervened in our hospital from January 2012 to January 2015 were enrolled in the study. According to the doctor＇s recommendation and the wishes of the patient ＂s family, the patients were randomly divided into the triple antithrombotie therapy group （TF group）, double antithrombotic therapy group （ DT group） and warfarin combined with clopidogrel group （ W ＋ C group）. All patients were followed up for 2 years ,and the incidence rates of major bleeding events and major cardiovascular and cerebrovascular events and INR success rate were statistically analyzed. Results The total incidence of major bleeding events in TT group was significantly higher than that in DT group and that in W ＋ C group （ P 〈 0. 05 ） but there was no significant difference between DT group and W ＋ C group （ P 〉 0.05 ）. The total incidence of major cardiovascular and eerebrovaseular events in TT group was significantly lower than that in DT group （P 〈 0. 05 ） , and there were no significant differences between TT group and W ＋ C group, between DT group and W ＋ C group （P 〉 0.05 ）. The INR success rate of rITE group per month were lower than W ＋ C group, but there were no significant differences （ P 〉 0. 05 ）. Conclusion The application of triple antithrombotic therapy in patients with AF after drug-eluting stents intervened can significantly reduce the incidence rates of stroke, myocardial infarction and other major cardiovascular events but the bleeding risk is relativelyhigher. Though th treatment can reduce the relatively higher. e combined treatment of ouble antithrombotic therapy, warfarin and clopidogrel risk of bleeding, the incidence of cardiovascular and cerebrovascular events is relatively higher.

关 键 词：房颤 支架 抗凝方案 出血风险 

分 类 号：R547.75[医药卫生—心血管疾病]