三联及二联抗凝用于冠心病合并心房颤动患者冠状动脉支架术后的疗效  被引量:6

Therapeutic effect of triple and dual anticoagulation on patients with coronary heart disease complicated atrial fibrillation after PCI

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作  者:张青 ZHANG Qing(Department of Cardiology,Second People’s Hospital of Liaocheng City,Liaocheng,Shandong,252600,China)

机构地区:[1]聊城市第二人民医院心内科,山东聊城252600

出  处:《心血管康复医学杂志》2022年第4期455-460,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘  要:目的:探讨三联及二联抗凝治疗用于冠心病合并心房颤动患者冠状动脉介入术(PCI)后的疗效。方法:我院接受PCI治疗的128例冠心病合并心房颤动患者被随机分为二联抗凝组(氯吡格雷+阿司匹林)和三联抗凝组(氯吡格雷+阿司匹林+华法林),各64例。治疗12个月后,比较两组治疗前后血清血小板计数(PLT)、C反应蛋白(CRP)、D-二聚体(D-D)、纤维蛋白原(Fg)、可溶性CD40配体(sCD40L)、髓过氧化物酶(MPO)水平的变化,观察出血事件及不良心脑血管事件发生率。结果:治疗后,两组血清PLT、CRP、D-D、Fg、MPO、sCD40L水平均显著低于治疗前(P均=0.001);且与二联抗凝组比较,三联抗凝组治疗后血清PLT[(298.3±54.32)×10^(9)比(148.9±23.15)×10^(9)]、CRP[(16.84±4.52)mg/L比(7.89±1.63)mg/L]、D-D[(0.36±0.09)mg/L比(0.20±0.07)mg/L]、Fg[(5.60±1.42)g/L比(2.15±0.64)g/L]、MPO[(164.14±22.14)μg/ml比(112.05±22.10)μg/ml]、sCD40L[(275.50±20.42)pg/ml比(208.55±24.62)pg/ml]水平降低更显著(P均=0.001);三联抗凝组不良心脑血管事件发生率显著降低(26.56%比9.38%,P=0.011);两组出血事件发生率无显著差异(P=0.225)。结论:冠心病合并心房颤动患者PCI术后行三联抗凝治疗能显著改善外周血流动力学,降低不良心脑血管事件发生率,且并未增加出血事件发生率。Objective:To explore therapeutic effect of triple and dual anticoagulation on patients with coronary heart disease(CHD)complicated atrial fibrillation(AF)after percutaneous coronary intervention(PCI).Methods:A total of 128 CHD+AF patients undergoing PCI in our hospital were randomly divided into dual anticoagulation group(received clopidogrel+aspirin)and triple anticoagulation group(received clopidogrel+aspirin+warfarin),64 cases in each group.After 12-month treatment,platelet count(PLT),serum levels of C reactive protein(CRP),D-dimer(D-D),fibrinogen(Fg),soluble CD40 ligand(sCD40 L)and myeloperoxidase(MPO)before and after treatment,incidence rates of hemorrhage and adverse cardio-and cerebrovascular events(ACCE)were compared between two groups.Results:Compared with before treatment,there were significant reductions in serum levels of PLT,CRP,D-D,Fg,MPO and sCD40 L in two groups after treatment,P=0.001 all;compared with dual anticoagulation group after treatment,there were significant reductions in serum levels of PLT[(298.3±54.32)×10^(9) vs.(148.9±23.15)×10^(9)],CRP[(16.84±4.52)mg/L vs.(7.89±1.63)mg/L],D-D[(0.36±0.09)mg/L vs.(0.20±0.07)mg/L],Fg[(5.60±1.42)g/L vs.(2.15±0.64)g/L],MPO[(164.14±22.14)μg/ml vs.(112.05±22.10)μg/ml]and sCD40 L[(275.50±20.42)pg/ml vs.(208.55±24.62)pg/ml]in triple anticoagulation group,P=0.001 all;incidence rate of ACCE was significantly lower in triple anticoagulation group(26.56%vs.9.38%,P=0.011).There was no significant difference in incidence rate of hemorrhage between two groups,P=0.225.Conclusion:Triple anticoagulant therapy after PCI can significantly improve peripheral hemodynamics,reduce incidence rate of ACCE and is without increasing incidence rate of hemorrhage in CHD+AF patients.

关 键 词:冠心病 心房颤动 血管成形术 气囊 冠状动脉 

分 类 号:R541.4[医药卫生—心血管疾病]

 

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