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目的评价冠心病合并心房颤动(房颤)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后华法林联合氯吡格雷抗栓策略的有效性和安全性。方法入选2012年1月—2013年12月在河南中医学院一附院冠心病合并房颤患者86例。所有患者PCI术后均服用华法林和氯吡格雷(75mg/d)并同时应用低分子肝素5~7d,随后检测国际标准化比值(international normalized ratio,INR)达1.8后停用低分子肝素,调整华法林剂量使国际标准化比值维持在2.0~2.5之间。术后12个月停用氯吡格雷,华法林继续服用。结果主要不良心脏事件发生率为1.16%(1/86);出血事件发生率为5.81%(5/86),其中次要出血事件1例,轻微出血事件4例;所有患者均未出现支架内亚急性血栓形成及缺血事件。结论冠心病合并房颤患者PCI术后经低分子肝素过渡治疗后联用华法林及氯吡格雷12个月是安全、有效的。
Objective To evaluate the efficacy and safety of warfarin plus clopidogrel antithrombotic strategy in patients with coronary heart disease complicated with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). Methods One hundred and sixty-six patients with coronary artery disease and atrial fibrillation were enrolled in the First Affiliated Hospital of Henan College of Traditional Chinese Medicine from January 2012 to December 2013. All patients were treated with warfarin and clopidogrel (75mg / d) and low molecular weight heparin for 5 ~ 7 days after PCI. Then, low molecular weight heparin was stopped after the international normalized ratio (INR) reached 1.8. Warfarin dose adjustment to maintain the international standardization ratio between 2.0 to 2.5. Clopidogrel discontinuation 12 months after surgery, warfarin continue to take. Results The incidence rate of major adverse cardiac events was 1.16% (1/86). The incidence of bleeding events was 5.81% (5/86), including 1 minor bleeding event and 4 mild bleeding events. All the patients had no stent-graft Subacute thrombosis and ischemic events. Conclusion The combination of warfarin and clopidogrel in patients with coronary heart disease complicated with atrial fibrillation after low molecular weight heparin transitional therapy after PCI is safe and effective.