老年心房颤动患者经皮冠状动脉介入术后双联抗栓治疗的方案研究  

Scheme study on dual antithrombotic therapy in elderly patients with atrial fibrillation after percutaneous coronary intervention

作　　者：黄柏松 丛洪良[2] Huang Bosong;Cong Hongliang(Graduate School,Tianjin Medical University,Tianjin 300070,China;Department of Cardiology,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津医科大学研究生院,300070 [2]天津市胸科医院心内科,300222

出　　处：《中国心血管杂志》2021年第4期317-322,共6页Chinese Journal of Cardiovascular Medicine

摘　　要：目的分析CHA_(2)DS_(2)-VASc评分为高危风险的非瓣膜性心房颤动(房颤)合并急性冠状动脉综合征的老年患者经皮冠状动脉介入(PCI)术后采用不同药物组合双联抗栓治疗方案的临床获益和出血风险,探究抗凝剂和血小板聚集抑制剂的最佳搭配方案及优先选择药物。方法纳入2018年9月至2020年8月天津市胸科医院心内科诊治的符合研究标准的老年患者共590例,根据双联抗栓药物组合方式非随机分为利伐沙班+氯吡格雷组157例、利伐沙班+替格瑞洛组146例、达比加群+氯吡格雷组153例和达比加群+替格瑞洛组134例,回顾性分析患者的临床及随访资料,比较6~12个月后终点结局指标差异。结果4组间临床基线资料比较,差异均无统计学意义(均为P>0.05)。研究结束时,4组间血栓栓塞复合事件发生率(14.6%、13.0%、19.6%比17.9%,χ_(2)=2.955,P=0.399)、药物累计出血事件发生率(14.6%、17.8%、17.0%比22.4%,χ_(2)=3.061,P=0.382)及出血事件严重程度分型比例(大出血:χ_(2)=2.993,P=0.393;小出血:χ_(2)=2.376,P=0.498;轻微出血:χ_(2)=1.730,P=0.630)比较,差异均无统计学意义(均为P>0.05)。结论CHA_(2)DS_(2)-VASc评分为高危风险的非瓣膜性房颤合并急性冠状动脉综合征的老年患者PCI术后使用利伐沙班+氯吡格雷、利伐沙班+替格瑞洛、达比加群+氯吡格雷、达比加群+替格瑞洛4种双联抗栓治疗方案6~12个月后均安全有效,临床预后未显示差异,无优先级选择推荐。Objective To investigate the clinical benefit and bleeding risk of dual antithrombotic therapy with different combination types in the elderly acute coronary syndrome(ACS)patients with non-valvular atrial fibrillation(AF).To explore the best combination of anticoagulants and platelet aggregation inhibitors when the patients undergoing percutaneous coronary intervention(PCI)complication with high-risk of CHA_(2)DS_(2)-VASc score.Methods A total of 590 elderly patients in the Department of Cardiology of Tianjin Chest Hospital who met the inclusive and exclusive criteria were enrolled from September 2018 to August 2020.According to the combination of antithrombotic drug,the patients were non-randomly divided into four groups:157 patients in the rivaroxaban+clopidogrel group,146 patients in the rivaroxaban+ticagrelor group,153 patients in the dabigatran+clopidogrel group and 134 patients in the dabigatran+ticagrelor group.Those patients were followed up for 6 to12 months.The clinical data and follow-up data were compared.Results There were no statistically significant differences appeared in the baseline data among the four groups(all P>0.05).At the end of the study,no statistically significant differences were shown in the thromboembolic complex events(14.6%vs.13.0%vs.19.6%vs.17.9%,χ_(2)=2.955,P=0.399),the accumulative bleeding events(14.6%vs.17.8%vs.17.0%vs.22.4%,χ_(2)=3.061,P=0.382),and the severity events of bleeding(major bleeding:χ_(2)=2.993,P=0.393;minor bleeding:χ_(2)=2.376,P=0.498;mild bleeding:χ_(2)=1.730,P=0.630)among the four groups(all P>0.05).Conclusions When the elderly ACS patients with high CHA_(2)DS_(2)-VASc score AF need PCI,rivaroxaban+clopidogrel,rivaroxaban+ticagrelor,dabigatran+clopidogrel or dabigatran+ticagrelor are all safe and effective during 6 to 12 months.The clinical prognosis shows no difference,and no priority selection is recommended.

关 键 词：非瓣膜性心房颤动 经皮冠状动脉介入治疗 老年人 CHA_(2)DS_(2)-VASc评分 抗凝剂 血小板聚集抑制剂 

分 类 号：R541.75[医药卫生—心血管疾病]