房颤合并冠心病患者冠脉支架植入术后二联和三联抗凝治疗的对比研究  

Comparison of therapeutic effects between dual- and triple-anticoagulant therapy after PCI in AF patients with CHD

作　　者：庄红[1] 张苏川[1] 尹俊[1] 蒋伟[1] 姚峰[1] 刘波[1] 黄璐 杨萍 代天 邹勇[1] ZHUANG Hong;ZHANG Su-chuan;YIN Jun;JIANG Wei;YAO Feng;LIU Bo;HUANG Lu;YANG Ping;DAI Tian;ZOU Yong(Department of Cardiology, Affiliated Hospital of Jianghan University, Wuhan, Hubei, 430015, China)

机构地区：[1]江汉大学附属医院心血管内科

出　　处：《心血管康复医学杂志》2019年第3期323-326,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨房颤合并冠心病患者冠脉支架植入术后二联和三联抗凝治疗对出血事件、实验室指标及心血管事件的影响。方法:选择100例房颤并冠心病患者资料进行分析,所有对象均行冠脉支架植入手术,术后予以抗凝治疗,二联治疗组(50例)予以二联抗凝方案,三联治疗组(50例)予以三联抗凝方案;12个月后,比较两组治疗前后血C反应蛋白(CRP)、血小板计数(PLT)、纤维蛋白原(Fg)、D-二聚体(D-D)水平变化,治疗期间出血事件与不良心血管事件发生情况。结果:治疗12个月后,与二联治疗组比较,三联治疗组血CRP[(16.81±4.49)mg/L比(7.86±1.64)mg/L]、PLT[(298.47±54.33)×10^9/L比(148.89±23.11)×10^9/L]、Fg[(5.59±1.41)g/L比(2.14±0.56)g/L]和D-D[(0.37±0.08)mg/L比(0.21±0.06)mg/L]水平均显著降低(P均=0.001);三联治疗组不良心血管事件发生率显著低于二联治疗组(6.00%比22.00%,P=0.021);两组出血事件无显著差异(P=0.182)。结论:房颤合并冠心病患者在冠脉支架植入术后实行三联抗凝治疗可显著提高临床疗效,且用药安全性高,值得推广。Objective:To explore influence of dual- and triple-anticoagulant therapy on hemorrhage events, laboratory indexes and cardiovascular events after percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF) complicated coronary heart disease (CHD). Methods:Clinical data of 100 AF + CHD patients were analyzed. All subjects received PCI and anticoagulant therapy after PCI. Dual-therapy group (n=50) received dual-anticoagulant program and triple-therapy group (n=50) received triple-anticoagulant program. Levels of blood C reactive protein (CRP), fibrinogen (Fg), D-dimer (D-D) and platelet count (PLT) before and after treatment, incidence of hemorrhage events and adverse cardiovascular events during treatment were compared between two groups. Results:Compared with dual-therapy group after 12-month treatment, there were significant reductions in blood levels of CRP[(16.81±4.49) mg/L vs.(7.86±1.64) mg/L], PLT[(298.47±54.33)×10^9 /L vs.(148.89±23.11)×10^9 /L], Fg[(5.59±1.41) g/L vs.(2.14±0.56) g/L]and D-D[(0.37±0.08) mg/L vs.(0.21±0.06) mg/L]in triple-therapy group, P =0.001 all. Incidence rate of adverse cardiovascular events in triple-therapy group was significantly lower than that of dual-therapy group (6.00% vs. 22.00%, P =0.021), there was no significant in incidence rate of hemorrhage events between two groups, P =0.182. Conclusion:Triple-anticoagulant therapy can significantly improve therapeutic effect with high safety in AF + CHD patients after PCI, which is worth extending.

关 键 词：心房颤动 冠心病 支架 抗凝药 

分 类 号：R541.75[医药卫生—心血管疾病]