摘要
目的 评价不同剂量利伐沙班+双联抗血小板治疗(DAPT)三联抗栓疗法对急性冠状动脉综合征(ACS)行经皮冠状动脉介入治疗(PCI)支架置入术的高危血栓栓塞风险的非瓣膜性心房颤动(NVAF)患者的疗效和安全性。方法 回顾性分析从2017年8月至2019年8月在天津市胸科医院就诊的528例行支架置入术的合并ACS的高危血栓栓塞风险的NVAF患者,按用药种类和剂量分为利伐沙班20 mg QD+DAPT组(127例)、利伐沙班15 mg QD+DAPT组(138例)、利伐沙班10 mg QD+DAPT组(151例)和华法林+DAPT组(112例),分析服药6个月后临床定义的主要不良心血管事件及出血事件的发生率。结果 服药6个月后,和利伐沙班20 mg QD+DAPT、华法林+DAPT标准三联抗栓疗法组相比,利伐沙班15 mg QD+DAPT组、利伐沙班10 mg QD+DAPT三联抗栓疗法组的心血管事件发生率差异均无统计学意义(均为P>0.05),利伐沙班15 mg QD+DAPT组、利伐沙班10 mg QD+DAPT组均可显著降低具有临床意义的轻微出血事件发生率(均为P<0.05)。结论 与标准剂量利伐沙班联合DAPT或华法林联合DAPT的三联抗栓疗法比较,ACS接受PCI支架置入术的高危血栓栓塞风险NVAF患者术后服用中等或低剂量利伐沙班联合DAPT的三联抗栓疗法治疗6个月后的临床抗栓效果相似,且安全性更优。
Objective To evaluate the efficacy and safety of different doses of rivaroxaban plus dual antiplatelet therapy(DAPT) triple antithrombotic therapy in high-risk thromboembolism non-valvular atrial fibrillation(NVAF) patients with acute coronary syndrome(ACS) undergoing stent placement and percutaneous coronary intervention(PCI).Methods A total of 528 528 NVAF patients with high-risk thromboembolic risk of ACS who underwent stent placement in Tianjin Chest Hospital from August 2017 to August 2019 were retrospectively enrolled.Based on the drug’s type and dose,patients were divided into rivaroxapar 20 mg QD+DAPT group(n=127),rivaroxaban 15 mg QD+DAPT group(n=138),rivaroxaban 10 mg QD+DAPT group(n=151) and warfarin+DAPT group(n=112).Incidences of clinically defined major adverse cardiovascular events and bleeding events after 6 months of treatment were analyzed.Results After taking the drugs for 6 months,compared with standard triple antithrombotic therapy of rivaroxaban 20 mg QD+DAPT or warfarin+DAPT groups,rivaroxaban 15 mg QD+DAPT group and rivaroxaban 10 mg QD+DAPT group were associated with similar rates of adverse cardiovascular events(all P>0.05),and with significantly reduced incidence of clinically significant minor bleeding events(all P<0.05).Conclusions Compared with standard triple antithrombotic therapy of rivaroxaban plus DAPT or warfarin plus DAPT,6 months treatment with low to intermediate dose of rivaroxaban plus DAPT has similar antithrombotic efficacy and better safety in NVAF patients with high-risk thromboembolic risk of ACS who underwent stent placement and PCI.
作者
黄柏松
丛洪良
Huang Bosong;Cong Hongliang(Graduate School,Tianjin Medical University,Tianjin 300070,China;Department of Cardiology,Tianjin Chest Hospital,Tianjin 300222,China)
出处
《中国心血管杂志》
2022年第2期139-144,共6页
Chinese Journal of Cardiovascular Medicine
关键词
非瓣膜性心房颤动
冠状动脉疾病
三联抗栓
预后
Non-valvular atrial fibrillation
Coronary artery disease
Triple antithrombotic therapy
Prognosis
