高风险冠心病合并房颤用抗凝和双联抗栓治疗的疗效及安全性观察(1)
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[摘要] 目的 观察冠心病合并房颤患者抗栓与抗凝治疗的疗效及安全性。 方法 将67例栓塞风险评分(CHADS2)为3～6分，出血风险评分(HEMORR2HAGES)>2分的冠心病合并房颤患者随机分为抗凝组与抗栓组，抗凝组使用华法林钠，抗栓组使用阿司匹林和氢氯吡格雷，随访观察4年，比较两组栓塞事件及出血事件的发生情况，并重新使用2010版血栓栓塞风险评估评分法(CHA2DS2-VASC)和出血风险评估法(HAS-BLED)进行回顾性评分。 结果 抗凝组栓塞事件发生较抗栓组明显减少，两组差异有统计学意义；而出血风险抗凝组较抗栓组有增高趋势，但差异无统计学意义。 结论 抗凝治疗可以减少高卒中高出血风险冠心病合并房颤患者栓塞风险。
[关键词] 冠心病合并房颤；抗凝治疗；抗栓治疗；安全性评估
[中图分类号] R972 [文献标识码] A [文章编号] 1674-4721(2012)02(c)-0075-02
Safety and efficacy observation of high risk coronary heart disease with atrial fibrillation by anticoagulation and thermodynamic bolt treatment
LIN Minyu LIU Jing YU Bijing ZHENG Boren
The Second Hospital of Fuzhou City in Fujian Province, Fuzhou 350007, China
[Abstract] Objective To observe the effect and safety of antithrombolic therapy and anticoagulation therapy for patients with high risk coronary heart disease (CHD) with atrial fibrillation (AF). Methods Sixty seven cases of embolism risk score (CHADS2) of 3 to 6, the bleeding risk score (HEMORR2HAGES) > 2 points in patients with coronary heart disease and atrial fibrillation were randomly divided into anticoagulation therapy group and antithromboic therapy group, anticoagulation therapy group were given warfarin sodium, antithrombotic therapy group used aspirin and hydrogen clopidogrel. Patients were followed up more than 4 years, the incidences of embolism and hemorrhage were compared. And the 2010 version of thromboembolic risk assessment score (CHA2DS2-VASC) and bleeding risk assessment (HAS-BLED) were re-used to retrospective rating. Results The incidences of embolism observed to be higher in antithrombolic therapy group (P < 0.05), the incidences of hemorrhage had no significant difference between two groups (P > 0.05). Conclusion Anticoagulation therapy can reduce the incidences of thromboembolism events in CHD patients with AF who have high risk of thromboembolism and hemorrhage.
[Key words] Coronary heart disease and Atrial fibrillation; Anticoagulation therapy; Antithromboic therapy; Safety observation
冠心病(CHD)合并房颤(AF)患者抗凝治疗面临着减少栓塞事件和减少出血风险两个难点。2010年版ESC房颤治疗指南提出了新的血栓栓塞风险评估评分法(CHA2DS2-VASC)和出血风险评估法(HAS-BLED)[1]两种评估法 ......
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