恶性肿瘤合并心房颤动对抗凝治疗后患者血栓栓塞和出血发生的影响

目的探讨恶性肿瘤合并心房颤动对抗凝治疗后患者血栓栓塞和出血发生的影响。方法选取39例恶性肿瘤合并心房颤动患者作为观察组,同期40例心房颤动患者作为对照组,均进行CHADS2房颤血栓危险度评分及HAS-BLED评分-出血风险评估,并给予华法林抗凝治疗,观察比较2组抗凝治疗后患者血栓栓塞和出血发生情况。结果观察组、对照组CHADS2评分分别为(3.02±0.71)分、(2.89±0.65)分,前者略高于后者,但差异无统计学意义(P>0.05);2组的血栓中危、高危患者比例差异亦无统计学意义(P>0.05)。观察组心肌梗死、下肢静脉栓塞、肺栓塞发生率略高于对照组,但差异无统计学意义(P>0.05)。观察组、对照组HAS-BLED评分分别为(2.30±0.42)分、(2.19±0.37)分,前者略高于后者,但差异无统计学意义(P>0.05),2组患者均为出血低危风险。观察组的皮肤出血点/瘀斑、齿龈渗血发生率显著高于对照组,组间差异有统计学意义(P<0.05),组间其他出血事件发生率差异无统计学意义(P>0.05)。观察组不良反应发生率为38.5%,显著高于对照组的17.5%,组间差异有统计学意义(P<0.05)。结论恶性肿瘤合并心房颤动一定程度上增加了血栓栓塞和出血风险,需要根据患者具体情况选择合理的治疗方案以提高抗凝疗效,减少血栓栓塞和出血不良事件的发生。

Effects of Thromboembolism and Bleeding in Patients with Malignant Tumors and Atrial Fibrillation after Anticoagulation Therapy

Objective To investigate the effects of thromboembolism and bleeding in patients with malignant tumors and atrial fibrillation after anticoagulation therapy.Methods 39 patients with malignant tumors and atrial fibrillation were selected as the observation group,and 40 patients with atrial fibrillation as the control group during the same period,they were all subjected to CHADS2 atrial fibrillation thrombosis risk score and HAS-BLED Scoring-Bleeding risk assessment,and received warfarin anticoagulation therapy,the occurrence of thromboembolism and bleeding after anticoagulation therapy in the 2 groups were observed and compared.Results The observation group and control group had CHADS2 scores of(3.02±0.71)and(2.89±0.65)respectively,the former was slightly higher than the latter,but the difference was not statistically significant(P>0.05),and there was no statistically significant difference in the proportion of patients with moderate or high risk of thrombosis between the 2 groups(P>0.05).The incidence of myocardial infarction,lower limb venous embolism and pulmonary embolism in the observation group were slightly higher than those in the control group,and the differences were not statistically significant(P>0.05).The HAS-BLED scores of the observation group and the control group were(2.30±0.42)and(2.19±0.37)respectively,the former was slightly higher than the latter,but the difference was not statistically significant(P>0.05),both groups of patients were bleeding low risk.The incidence of skin haemorrhage/ecchymosis and gingival bleeding in the observation group were significantly higher than those in the control group,the differences between the 2 groups were statistically significant(P<0.05),and the incidence of other bleeding events between the 2 groups was not statistically significant(P>0.05).The incidence of adverse reactions in the observation group was 38.5%,significantly higher than 17.5%in the control group,and the difference between the 2 groups was statistically significant(P<0.05).Conclusion Malignant tumors with atrial fibrillation increase the risk of thromboembolism and bleeding to a certain extent,it is necessary to choose a reasonable treatment plan according to patients′specific situation,it can improve the anticoagulant effect and reduce thromboembolism and adverse bleeding events.