Clinical manifestations of acute coronary syndrome patients combined with atrial fibrillation and comparison of different antithrombotic therapies after coronary stent implantation
QIAN Hao
Department of Internal Medicine, Chinese Academy of Medical Science & Peking Union Medical College, Peking Union Medical College Hospital, Beijing 100730, China
Abstract：Objective To compare the efficacy and safety of different antithrombotic therapies in patients after coronary stent implantation through follow-up.Methods The cross-sectional observation study enrolled 1674 ACS patients who had undergone PCI in our hospital. According complications with (n=78) or without (n=1596) atrial fibrillation, these patients were divided into two groups and their clinical manifestations were compared. We followed up 54 patients with CHA2DS2-VASc≥2 in the group combined with atrial fibrillation for one year. According to the antithrombotic regimens, these patients were divided into warfarin group(n=19) or non-warfarin group(n=35). SPSS 19.0 was used for statistical analysis.Results The rate of triple vessel lesion was higher in the group combined with atrial fibrillation, and the incidence of death during the in-hospital period(12.8% vs 1.8%, P0.001) was significantly higher than in the group without atrial fibrillation. During the follow-up, significantly more proton pump inhibitors (PPIs) were used in warfarin group than in non-warfarin group (100% vs 51.7%, P0.001). The incidence of minimal bleeding in warfarin group was higher than in non-warfarin group (21.1% vs 2.9%, P=0.028).Conclusions Triple antithrombotic therapy is recommended for patients with ACS after coronary stent implantation. Proper use of PPI may achieve good efficacy and safety.
Hylek E M, Go A S, Chang Y, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation[J]. N Engl J Med, 2003, 349(11) 1019-1026.
Marte T, Saely C H, Schmid F, et al. Effectiveness of atrial fibrillation as an independent predictor of death and coronary events in patients having coronary angiography[J]. Am J Cardiol, 2009,103(1)36-40.
[5]
Kay W H, Ivanov J, Freixa X,et al. Antithrombotic therapy after coronary dtenting in patients with nonvalvular atrial fibrillation[J].Canadian J Cardio, 2013, 29(2) 213-218.
[6]
Ruff C T, Giugliano R P, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation a meta-analysis of randomised trials[J]. Lancet,2014, 383(9921)955-962.
[7]
Mega J L, Braunwald E, Wiviott S D, et al. Rivaroxaban in patients with a recent acute coronary syndrome[J].N Engl J Med, 2012,366(1)9-19.
[8]
Oldgren J, Budaj A, Granger C B, et al. Dabigatran vs. placebo in patients with acute coronary syndromes on dual antiplatelet therapy a randomized, double-blind, phase II trial[J].Eur Heart J, 2011, 32(22)2781-2789.
[9]
Khurram Z, Chou E, Minutello R, et al. Combination therapy with aspirin, clopidogrel and warfarin following coronary stenting is associated with a significant risk of bleeding[J].J Invasive Cardiol, 2006, 18(4)162-164.
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