基于利伐沙班的不同疗程三联抗栓方案对ACS合并AF的老年患者PCI后远期预后的影响  

Influence of triple antithrombotic therapy based on rivaroxaban in different courses on long-term prognosis in elderly patients with ACS complicated by AF after PCI

作　　者：柳彦涛[1] 张艳艳 李叶宁[1] 徐欢欢[1] Liu Yantao;Zhang Yanyan;Li Yening;Xu Huanhuan(Department of Critical Care Medicine,Central Hospital of Luohe City,Louhe 462000,China)

机构地区：[1]河南省漯河市中心医院重症医学科,漯河462000

出　　处：《中国循证心血管医学杂志》2021年第9期1104-1107,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨不同疗程的利伐沙班联合双抗血小板药物的三联抗栓治疗对接受经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)合并心房颤动(AF)的老年患者远期预后的影响。方法按照纳入及排除原则选取2017年4月至2019年3月于漯河市中心医院重症监护病房收治的ACS合并AF患者240例作为研究对象,随机分为三联抗栓6个月组(观察组)和三联抗栓1个月组(对照组)各120例,每组在结束三联抗栓疗程后立即过渡为利伐沙班联合单抗血小板治疗方案,连续随访12个月。记录随访期间出血事件、死亡、缺血性卒中及主要不良心血管事件(MACE)的发生情况和发生日期。结果两组患者总出血事件及根据ISTH分级原则进行分级,各种程度出血事件均无统计学差异(P>0.05);两组患者的总MACE事件发生率无统计学差异(P>0.05),但PCI后再发心肌梗死与再次血运重建方面,两组间存在显著差异(P<0.05)。结论对于PCI后ACS合并AF的老年患者,延长基于利伐沙班的三联抗栓下的双抗血小板药物使用时间是安全的,但缩短双抗血小板疗法(DAPT)时间可能增加老年ACS患者PCI后冠状动脉疾病再度恶化风险。Objective To investigate the influence of triple antithrombotic therapy based on rivaroxaban combined with double anti-platelet drugs in different courses on long-term prognosis in elderly patients with acute coronary syndrome(ACS)complicated by atrial fibrillation(AF)after PCI.Methods The patients with ACS complicated by AF(n=240)were chosen from Intensive Care Unit in Central Hospital of Luohe City from Apr.2017 to Mar.2019,and divided randomly into 6-month triple antithrombotic therapy group(observation group)and 1-month triple antithrombotic therapy group(control group,each n=120).After triple antithrombotic therapy finished,2 groups were immediately given rivaroxaban+anti-platelet therapy,and then followed up continuously for 12 months.The incidence rates and dates of bleeding events,death,ischemia stroke and major adverse cardiovascular events(MACE)were recorded in 2 groups during follow-up period.Results There was no statistical difference in the total bleeding events and bleeding events in varying degrees graded according to ISTH classification principle between 2 groups(P>0.05).The total incidence rate of MACE had no statistical difference between 2 groups(P>0.05),while relapsed myocardial infarction and re-revascularization had significant difference between 2 groups after PCI(P<0.05).Conclusion It is safe to extend the time of double antiplatelet therapy in triple antithrombotic therapy based on rivaroxaban in elderly patients with ACS complicated by AF,but shortening of double antiplatelet therapy time will induce the exacerbation of coronary artery disease.

关 键 词：利伐沙班 冠心病 急性冠脉综合征 心房颤动 抗凝治疗 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]