急性冠脉综合征合并房颤患者PCI术后应用利伐沙班和氯吡格雷双联抗栓的效果研究  

A study on the effectiveness and safety of rivaroxaban combined with clopidogrel in treatment of acute coronary syndromes complicated by atrial fibrillation after PCI

作　　者：白龙 杨晓红[1] 崔晓冉 符灵智 张冀东[1] BAI Long;YANG Xiaohong;CUI Xiaoran(Department of Cardiology,The Second Hospital of Hebei Medical University,Hebei, Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心内科,石家庄市050000

出　　处：《河北医药》2020年第21期3209-3213,共5页Hebei Medical Journal

基　　金：中国中青年临床研究基金-VG基金资助(编号:303-09-02-62)。

摘　　要：目的探讨急性冠脉综合征合并房颤患者经皮冠脉介入治疗(percutaneous coronary intervention,PCI)术后接受新型口服抗凝剂(new oral anticoagulants,NOAC)利伐沙班+氯吡格雷双联抗栓治疗的有效性及安全性利伐沙班。方法选择2018年1月至9月接受PCI术后的急性冠脉综合征合并非瓣膜病房颤患者100例,患者随机分为利伐沙班组和华法林组,利伐沙班组接受利伐沙班(15 mg,1次/d)+氯吡格雷(75 mg,1次/d)的双联治疗至PCI术后12个月;华法林组接受华法林+氯吡格雷(75 mg,1次/d)+阿司匹林(100 mg,1次/d)的三联治疗,方案为口服华法林,初始剂量1.5~3 mg,根据监测国际标准化比值(international normalized ratio,INR)结果调整剂量,在2~4周达到目标范围(INR 2.0~3.0),此后按指南要求监测INR调整华法林剂量,服用6个月后停用阿司匹林,华法林+氯吡格雷治疗,口服至术后12个月。患者随访12个月,主要疗效终点事件是12个月内出现的不良心脏和脑血管事件(adverse cardiac and cerebrovascular events,MACCE),次要终点事件是安全终点,包括12个月出现的心肌梗死溶栓治疗(TIMI)严重出血和轻微出血。结果随访12个月发现共8例(8.00%)发生MACCE事件,其中华法林组和利伐沙班组分别是5例(9.80%)和3例(6.10%),2组发生MACEE事件的风险差异无统计学意义(P=0.479)。另外发现共9例(9.00%)发生出血事件,其中华法林组和利伐沙班组分别是8例(15.69%)和1例(2.00%),华法林组的出血风险明显高于利伐沙班组(P=0.047)。结论急性冠脉综合征合并房颤的患者,在PCI术后接受新型口服抗凝剂利伐沙班+氯吡格雷双联治疗与传统的华法林+阿司匹林+氯吡格雷三联药物相比疗效相当,但安全性更高。Objective To investigate the effectiveness and safety of new oral anticoagulants(NOAC)-rivaroxaban combined with clopidogrel in treatment of acute coronary syndromes complicated by atrial fibrillation after percutaneous coronary intervention(PCI).Methods One hundred patients with acute coronary syndromes complicated by atrial fibrillation who underwent PCI in our hospital from January 2018 to September 2018 were enrolled in the study,who were randomly divided into two groups.The patients in experimental group were treated by rivaroxaban(15mg,once a day)+clopidogrel(75mg,once a day)until 12 months after PCI,however,the patients in control group were treated by warfarin+clopidogrel(75mg,once a day)+aspirin(100mg,once a day),until 12 months after PCI.The patients in both groups were followed up for 12 months,and the main curative effect endpoint event was the incidence of adverse cardiac and cerebrovascular events(MACCE)within 12 months,and the secondary curative effect endpoint event was safe endpoint,including the incidence of mild TIMI hemorrhage within 12 months.Results After 12-month follow up,a total of 8 patients(8.00%)had MACCE events,of whom,5 cases(9.80%)in control group and 3 cases(6.10%)in experimental group,there was no significant difference in the incidence of MACEE events between the two groups(P>0.05).In addition,a total of 9 patients(9.00%)had bleeding events,of whom,8 cases(15.69%)in control group and 1 case(2.00%)in experimental group,the bleeding risk in control group was significantly higher than that in experimental group(P<0.05).Conclusion The therapeutic effects of rivaroxaban combined with clopidogrel in treatment of acute coronary syndromes complicated by atrial fibrillation after PCI are similar to those of traditional warfarin+aspirin+clopidogrel medication,but,the former has higher safety.

关 键 词：房颤 冠心病 新型口服抗凝剂 氯吡格雷 

分 类 号：R541.4[医药卫生—心血管疾病]