一例房颤合并冠心病患者初始抗栓治疗策略及文献复习

目的 探讨房颤伴急性冠脉综合征的抗栓治疗策略。方法 1例46岁房颤合并冠心病的男性患者，房颤卒中风险低危，入院期间未给予抗凝治疗，后出现急性脑梗塞。通过提阅部分指南及文献，分析CHA₂DS₂-VAS_c评分为1分，并伴急性冠脉综合征患者的不同抗栓治疗策略方案及其优劣。结果 文献提示，CHA₂DS₂-VAS_c评分为1分出血低危患者，建议尽早服用抗凝药。双联抗栓（华法林+氯吡格雷）能够有效抗栓并且降低患者出血风险，因此需根据患者的具体情况，尽快将三联调整为双联抗栓（1~3个月内），保证患者疗效的情况下，降低患者出血风险。结论 临床上遇到相关患者需充分评估患者的出血及血栓风险，制定个体化的抗栓治疗策略。

A Case Study of Initial Antithrombotic Therapy of Atrial Fibrillation and Coronary Heart Disease and Literature Review

OBJECTIVE To study the antithrombotic strategy of atrial fibrillation(AF) combine with acute coronary syndrome (ACS). METHODS One male patient of atrial fibrillation combine with coronary heart disease (CHD) at age of 46 was at a low risk of stroke. Anticoagulant was not given, but stroke happened. By referring to some of the guidelines and literature, analyzed the different antithrombotic strategies and their advantages and disadvantages in patients with acute coronary syndrome with CHA2DS2-VASc score of 1. RESULTS The literature suggests that patients of 1 score of CHA₂DS₂-VASc with low risk of bleeding should be given anticoagulant. Warfarin + clopidogrel could effectively reduce the risk of bleeding in patients with antithrombotic. Therefore, dual antiplatelet therapy should be adjusted to triple clopidogrel in 1-3 months according to the specific circumstances of patient as soon as possible. CONCLUSION Bleeding and thrombosis shall be fully concerned, and of individual antithrombotic therapy strategy will be developed accordingly.