心房颤动合并冠心病经皮冠状动脉介入治疗后三联抗栓效果及不良心血管事件发生的影响因素  

Effects of triple antithrombotic therapy on atrial fibrillation patients with coronary artery disease after percutaneous coronary intervention and analysis of influencing factors for major adverse cardiovascular events

作　　者：闫增强 杜荣生 路林峰 孙玉翠 张彪 YAN Zeng-qiang;DU Rong-sheng;LU Lin-feng;SUN Yu-cui;ZHANG Biao(Department of Cardiology,Cangzhou People′s Hospital,Cangzhou 061000,Hebei,China;不详)

机构地区：[1]沧州市人民医院心血管内科,河北沧州061000 [2]河北省沧州中西医结合医院心血管内科,河北沧州061000

出　　处：《广东医学》2024年第11期1368-1373,共6页Guangdong Medical Journal

基　　金：沧州市重点研发计划(222106137)。

摘　　要：目的分析三联抗栓方案(华法林、阿司匹林联合氯吡格雷)在心房颤动(atrial fibrillation,AF)合并冠心病患者经皮冠状动脉介入治疗(PCI)后抗栓效果,并探究此类患者PCI后抗栓治疗后出血事件发生的影响因素。方法收集选择2020年1月至2022年1月收治的105例AF合并冠心病患者临床资料,根据患者术后抗栓治疗方案不同分为三联组37例(三联抗栓:华法林、阿司匹林联合氯吡格雷)、双抗组35例(阿司匹林和氯吡格雷,AC组)、华法林联合氯吡格雷组33例(WC组)。随访12个月,对比三组凝血功能指标[凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,Fib)]、主要不良心血管事件(major adverse cardiovascular events,MACE)、出血事件发生情况,分析患者抗栓治疗后发生出血事件的影响因素。结果治疗后3组PT、TT、APTT均明显升高,Fib值降低(P均<0.01),而3组间治疗后PT、TT、APTT、Fib值比较差异无统计学意义(P均>0.05)。三联组MACE发生率为2.7%,AC组为17.1%,WC组为18.2%,3组MACE发生率比较差异无统计学意义(P均>0.05)。AC组无严重出血事件发生,次要出血事件发生率为8.57%,总发生率为8.57%;WC组无严重出血事件发生,次要出血事件发生率为6.06%,总发生率为6.06%;三联组严重出血发生率为5.41%,次要出血事件发生率为13.51%,总发生率为18.92%,3组间比较差异无统计学意义(χ^(2)=2.906,P=0.231)。出血组与未出血组的年龄、HAS-BLED评分比较差异有统计学意义(P<0.05),出血组年龄(76.76±3.47)岁,明显大于未出血组的(59.62±3.33)岁,出血组HAS-BLED评分≥3分占比为100.0%,明显高于未出血组(31.1%)(P<0.05);两组的性别、基础疾病、AF类型、CHA2DS2-VASc评分比较差异无统计学意义(P>0.05)。出血与否为因变量(赋值X=0,X=1),将年龄(连续性变量)、HAS-BLED评分(赋值0≤3分,1≥3Objective To evaluate the efficacy of a triple antithrombotic regimen(warfarin,aspirin,and clopidogrel)in patients with atrial fibrillation(AF)and coronary artery disease(CAD)undergoing percutaneous coronary intervention(PCI)and investigate the factors influencing bleeding events in these patients after PCI.Methods Clinical data from 105 AF patients with CAD who received PCI from January 2020 to January 2022 were collected.Patients were divided into three groups based on their post-PCI antithrombotic regimen:the triple therapy group(37 cases on warfarin,aspirin,and clopidogrel),the AC group(35 cases on aspirin and clopidogrel),and the WC group(33 cases on warfarin and clopidogrel).Over a 12-month follow-up,coagulation parameters,including prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),and fibrinogen(Fib),incidence of major adverse cardiovascular events(MACE),and bleeding events were compared across groups,and the factors influencing bleeding events were analyzed.Results Post-treatment,PT,TT,and APTT significantly increased,while Fib levels decreased in all groups(P<0.01);however,no significant differences were observed among the groups for PT,TT,APTT,or Fib values after treatment(P>0.05).The incidence of MACE was 2.7%in the triple therapy group,17.1%in the AC group,and 18.2%in the WC group,with no significant difference between groups(P>0.05).In terms of bleeding events,no major bleeding occurred in the AC or WC groups;minor bleeding events occurred in 8.57%and 6.06%of cases,respectively.In the triple therapy group,the major bleeding rate was 5.41%,with minor bleeding at 13.51%,totaling 18.92%,with no significant difference between groups(χ^(2)=2.906,P=0.231).Age and HAS-BLED scores were significantly different between the bleeding and non-bleeding groups(P<0.05),with the bleeding group being older(76.76±3.47)years than the non-bleeding group(59.62±3.33)years.Additionally,100%of the bleeding group had a HAS-BLED score≥3,compared to 31.1%in the non-bleeding group(P<0.05).Lo

关 键 词：心房颤动 冠状动脉粥样硬化心脏病 经皮冠状动脉介入治疗 三联抗栓方案 治疗效果 出血事件 

分 类 号：R541.75[医药卫生—心血管疾病] R541.4[医药卫生—内科学]