Comparison of different antithrombotic therapies in patients with atrial fibrillation coronary artery disease after percutaneous coronary intervention
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摘要: 目的 关于房颤(atrial fibrillation,AF)合并冠心病经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后患者不同抗栓方案的比较。 方法 收集2015年1月-2016年6月间在滁州市第一人民医院住院治疗的90例房颤合并冠心病PCI术后患者,依据患者出院后使用的不同抗栓方案分为3组,即三联抗栓组(TT组,30例)、华法林联合氯吡格雷组(WS组,30例)、双抗组(DT组,30例)。3组其他辅助用药基本相同。记录随访12个月的临床终点事件并进行统计分析。 结果 患者总体卒中风险较高(CHA2DS2-VASc评分 ≥ 2分占58%),出血风险稍低(HAS-BLED ≥ 3分占49%),3组总体差异均无统计学意义(P>0.05)。三联抗栓治疗组的MACCE发生率最低(6.7%),且3组差异有统计学意义(χ2=6.193,P=0.045)。采用Bonferroni法进行两两比较,结果显示,TT组和DT组有差异(χ2=5.454,P=0.021),其余两组之间无统计学差异(P>0.05)。3组间TIMI主要出血发生率无差异(χ2=0.000,P=1.000),三联抗栓治疗组TIMI次要出血发生率较高(13.3%),但3组差异无统计学意义(χ2=1.098,P=0.577)。 结论 对于房颤合并冠心病PCI术后患者,从缺血性卒中率和MACCE率来看,TT组要优于DT组,WS组与DT组和TT组之间无差异。Abstract: Objective Comparison of different strategies in patients with atrial fibrillation (AF) complicated coronary heart disease (CHD) undergoing percutaneous coronary intervention (PCI). Methods A total of 90 AF+CAD patients undergoing PCI were divided into trigeminy antithrombotic therapy group (TT group, n=30), bigeminy antithrombotic therapy group[DT group, n=30] and warfarin and clopidogrel group (WS group, n=30) based on the antithrombotic therapies after discharge; Other secondary preventions were the same in these groups. These patients were followed up around 12 months for clinical outcome events the data of which were recorded and analyzed. Results The overall patients had higher risk of stroke (CHA2DS2-VASc score ≥ 2, 58%) and a slightly lower risk of bleeding(HAS-BLED score ≥ 3, 49%), but there was no significant statistical difference (P>0.05). Patients with triple antithrombotic therapy had a significant reduction in stroke and major adverse cardiac and cerebral events (MACCE, 6.7%, χ2=6.193, P=0.045). Bonferroni pairwise comparison indicated that TT and DT groups showed statistical significance(χ2=5.454, P=0.021) while the other two groups had no significant difference(P>0.05). The results showed that there was a difference between TT group and DT group (χ2=5.454, P=0.021) by Bonferroni method, but there was no statistical difference between the other two groups (P>0.05).The incidences of major bleeding among three groups had no statistical significance (χ2=0.000, P=1.000). The TT group had a high rate of secondary bleeding(13.3%) but the three groups had no significant difference (χ2=1.098, P=0.577). Conclusion For patients with atrial fibrillation complicated with coronary heart disease after PCI, the rate of ischemic stroke and MACCE in TT group was better than that in other group, and there was no difference between WS group and DT group.
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