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目前对于既有应用华法林指征且又植入冠状动脉支架者抗栓策略的选择尚缺乏大规模的循证医学证据。故现阶段,对于此类患者需慎重权衡出血和血栓的风险,选择个体化的抗栓策略。血栓栓塞低危或仅存一个中危因素的患者,可选用阿司匹林加氯吡格雷二联抗栓治疗,而对于存在1个以上中危因素或1个高危因素的患者则可能需要在严密监测国际标准化比率的基础上选择三联抗栓策略,而对于高龄患者,阿司匹林加氯吡格雷二联抗栓策略可能更为合适。
At present, there is no large-scale proof of evidence-based medicine for the selection of antithrombotic strategies in both patients who have warfarin indications and coronary stents. Therefore, at this stage, for such patients need to carefully weigh the risk of bleeding and thrombosis, choose individualized antithrombotic strategy. Patients who are at risk for thromboembolism or who have only one risk factor may be treated with aspirin plus clopidogrel plus antithrombotics while patients with more than one risk factor or a risk factor may need to be monitored closely Standardized ratio based on the choice of triple antithrombotic strategy, and for older patients, aspirin and clopidogrel combined antithrombotic strategy may be more appropriate.