利伐沙班与达比加群治疗房颤合并急性冠脉综合征患者PCI后的有效性和安全性对比  

Analysis of the effectiveness and safety of rivaroxaban vs dabigatran in the treatment of patients with atrial fibrillation and acute coronary syndrome undergoing PCI

作　　者：李庆勇[1] 汤宝鹏[2] 牛锁成 申文祥[1] 周贤惠[2] 芦颜美[2] LI Qing-Yong;TANG Bao-Peng;NIU Suo-Cheng(The Second Department of Cardiology,Puyang People's Hospital,Puyang 457000,Henan,China)

机构地区：[1]濮阳市人民医院心内二科,河南濮阳457000 [2]新疆医科大学一附院起搏电生理科

出　　处：《中国老年学杂志》2021年第1期1-4,共4页Chinese Journal of Gerontology

基　　金：国家自然科学基金(81570297)。

摘　　要：目的比较利伐沙班、达比加群、华法林分别联合一种P2Y12受体拮抗剂治疗心房颤动(AF)合并急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后的有效性和安全性。方法选择AF合并ACS并接受PCI的患者345例,随机分为3组,华法林组:服用P2Y12受体拮抗剂(氯吡格雷或者替格瑞洛)联合华法林国际标准化比值(INR)2~3,利伐沙班组:服用P2Y12受体拮抗剂联合利伐沙班(15 mg,1次/d),达比加群组:服用P2Y12受体拮抗剂联合达比加群(150 mg,2次/d),随访≥12个月,观察指标为:全因死亡率、国际血栓形成与止血法学会(ISTH)大出血、临床相关小出血(CRNMB)、脑卒中、周围动脉栓塞、再发心肌梗死及支架内血栓发生率,住院时间。结果三组间全因死亡率、ISTH大出血、脑卒中、心肌梗死、支架内血栓及周围栓塞率等未见统计学差异。利伐沙班和达比加群组CRNMB、住院时间明显低于华法林组(P<0.05),利伐沙班组与达比加群组之间未见统计学差异(P>0.05)。结论达比加群及利伐沙班在双联抗栓治疗(DAT)方案中是等效的且出血风险、住院时间低于华法林。Objective To compare the efficacy and safety of rivaroxaban,dabigatran and warfarin combined with a P2Y12 receptor antagonist in the treatment of patients with atrial fibrillation(AF)and acute coronary syndrome(ACS)after PCI.Methods From March 2016 to March 2019,345 patients with AF,ACS and PCI in hospital were randomly divided into three groups:warfarin group:taking a P2Y12 receptor antagonist(clopidogrel or tegrarol)combined with warfarin(INR2-3),rivasha group:taking a P2Y12 receptor antagonist combined with rivasha group(15 mg,once a day),dabigata group:taking a P2Y12 receptor antagonist combined with Dabigatran group(150 mg,2 times a day),follow-up 12 months.The observation indicators were all-cause mortality,ISTH major bleeding,CRNMB,stroke,peripheral artery embolism,myocardial infarction and stent thrombosis and days in hospital.Results There were no significant differences in all-cause mortality(χ^2=0.39,P=0.82),ISTH major bleeding(χ^2=0.63,P=0.73),stroke(χ^2=0.40,P=0.82),myocardial infarction(χ^2=0.05,P=0.97),stent thrombosis(χ^2=0.17,P=0.92)and peripheral embolism rate(χ^2=0.09,P=0.95)among the three groups.The CRNMB rate of rivaroxaban and dabigata group were significantly lower than those of warfarin group(χ^2=6.47,P=0.04),days in hospital of rivaroxaban and dabigata group was significantly lower than that of warfarin group(F=0.14,P=0.04),and there were no significant differences in CRNMB rate and days in hospital between rivaroxaban and dabigata group.Conclusions Dabigatran and rivaroxaban are equivalent in the dual antithrombotic(DAT)regimen and have a lower risk of bleeding and shorter time in hospital than warfarin.

关 键 词：心房颤动 急性冠脉综合征 经皮冠状动脉介入治疗 利伐沙班 达比加群 华法林 

分 类 号：R4[医药卫生—临床医学]