心房颤动合并冠心病并PCI患者三联与二联抗栓治疗的安全性和疗效比较

目的：对比观察心房颤动（AF）合并冠心病PCI术后患者三联抗栓治疗与双联栓治疗的安全性和有效性。方法：连续入选180例AF合并冠心病PCI术后患者,根据服用的抗栓药物分成两组：三联抗栓组[60例,服用阿司匹林（100mg/d）、氯吡格雷（75mg/d）和华法林],双联抗栓组[120例,服用阿司匹林（100mg/d）和氯吡格雷（75mg/d）],两组其他冠心病二级预防措施相同。对随访期间发生的出血事件、血栓栓塞事件以及主要不良心血管事件（MACE）进行统计分析。结果：所有患者中,168例（93.3%）完成了至少一年期随访。随访期间,两组出血事件发生率未达显著差异（18.3%比11.7%,P〉0.05）,三联抗栓组较双联抗栓组严重出血事件发生率增加3倍（3.3%比0.8%）,但无显著差异（P〉0.05）。Cox回归分析表明,年龄（HR 0.59,95%CI 0.40～0.83,P=0.025）和使用华法林（HR 1.33,95%CI 0.88～2.54,P=0.016）是随访1年期间出血事件的独立危险因素。两组MACE发生率差异无显著性（P〉0.05）。结论：对于房颤合并冠心病并PCI术后的患者,三联与二联抗栓治疗的安全性及疗效虽无显著差异,但三联抗栓治疗严重出血有增加的倾向,而且华法林是出血事件的独立危险因素,所以对于此类患者还是使用二联抗栓治疗为宜。

Comparison of safety and effect between trigeminy antithrombotic therapy and bigeminy antithrombotic therapy in AF complicated CHD patients undergoing PCI

Objective: To compare safety and effectiveness of trigeminy antithrombotic therapy and bigeminy antithrombotic therapy in patients with atrial fibrillation(AF) complicated coronary heart disease(CHD) undergoing percutaneous coronary intervention(PCI).Methods:A total of 180 AF+CHD patients undergoing PCI were divided into trigeminy antithrombotic therapy group [trigeminy group,n=60,received aspirin(100mgd),clopidogrel(75mgd) and warfarin] and bigeminy antithrombotic therapy group [bigeminy group,n=120,received aspirin(100mgd) and clopidogrel(75mgd)].Other secondary prevention was same in two groups.Statistical analyses were performed on bleeding,thrombus and major adverse cardiovascular events(MACE) during follow up.Results:Among all patients,a total of 168 cases(93.3%) completed at least one-year follow-up.During follow up,there was no significant difference in incidence rate of hemorrhage between two groups(18.3% vs.11.7%,P>0.05),incidence rate of severe hemorrhage in trigeminy group was three times more than that of bigeminy group(3.3% vs.0.8%),but no significant difference(P>0.05).Cox regression analysis indicated that age(HR 0.59,95%CI 0.40～0.83,P=0.025) and warfarin(HR 1.33,95%CI 0.88～2.54,P=0.016) were independent risk factors for hemorrhage during one-year follow up.There were no significant difference in incidence rate of MACE between two groups(P>0.05).Conclusion:Although there are no significant differences in safety and effect between trigeminy group and bigeminy group for AF+CHD patients undergoing PCI,but there is increase tendency of severe hemorrhage in trigeminy group,and warfarin is risk factor for hemorrhage,so must to take bigeminy therapy for these patients.