[1]张金晶 吕建峰 周敬群 代文静 孙培媛.心房颤动合并冠心病患者经皮冠脉介入术后抗栓治疗的研究进展[J].心血管病学进展,2020,(2):185-189.[doi:10.16806/j.cnki.issn.1004-3934.2020.02.022]
 ZHANG JinJingLU JianfengZHOU JingqunDAI WenjingHUANG DiSUN Peiyuan.Antithrombotic Therapy in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention[J].Advances in Cardiovascular Diseases,2020,(2):185-189.[doi:10.16806/j.cnki.issn.1004-3934.2020.02.022]
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心房颤动合并冠心病患者经皮冠脉介入术后抗栓治疗的研究进展()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2020年2期
页码:
185-189
栏目:
综述
出版日期:
2020-02-25

文章信息/Info

Title:
Antithrombotic Therapy in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention
作者:
张金晶 吕建峰 周敬群 代文静 孙培媛
(三峡大学附属仁和医院心血管内科,宜昌 443000)
Author(s):
ZHANG JinJingLU JianfengZHOU JingqunDAI WenjingHUANG DiSUN Peiyuan
(Department of Cardiology, Affiliated Renhe Hospital of Three Gorges UniversityYichang 443000HubeiChina)
关键词:
二联治疗心房颤动经皮冠脉介入抗栓治疗
Keywords:
Dual antithrombotic therapy Atrial fibrillation Percutaneous coronary intervention Antithrombotic therapy
DOI:
10.16806/j.cnki.issn.1004-3934.2020.02.022
摘要:
心房颤动合并冠心病患者经皮冠脉介入术后的抗栓治疗是临床工作者所面临的一个困境。传统的三联疗法即口服抗凝药+阿司匹林+P2Y12抑制剂出血率较高,现多项随机对照试验表明,新型口服抗凝药+P2Y12抑制剂疗法较传统三联疗法在不明显增加心血管不良事件的基础上能减少出血事件但二联疗法较三联疗法孰优孰劣还不能下定论。未来的研究或许会为这类患者的治疗提供一个最优的疗法。介绍这类患者抗栓疗法的最新进展,为临床实践提供参考。
Abstract:
Antithrombotic treatment for patients with atrial fibrillation complicated with coronary artery disease after percutaneous coronary intervention(PCI) poses a treatment dilemma to clinical workers.Traditional triple antithrombotic therapy comprising of aspirin, a P2Y12 inhibitor and an oral anticoagulant is associated with high bleeding rates,now some randomized controlled trials(RCTs) have shown that dual antithrombotic therapy comprising of NOACs and P2Y12 inhibitor can reduce bleeding events without significantly increasing ischemic events than triple antithrombotic therapy. Nevertheless, it may be too early to declare dual or triple therapy as a winner. Future research may provide an optimal treatment for these patients. This review will introduce the latest researches on antithrombotic therapy about these patients, and provide reference for clinical practice.

参考文献/References:

[1] Ball J, Thompson DR, Ski CF, et al. Estimating the current and future prevalence of atrial fibrillation in the Australian adult population[J]. Med J Aust, 2015,202(1): 32-35.
[2] Kirchhof P, Benussi S, Kotecha D, et al.2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS[J]. Kardiol Pol, 2016,74(12):1359-1469.
[3] January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society[J]. Heart Rhythm, 2019,16(8):e66–e93.
[4] Angiolillo DJ, Goodman SG, Bhatt DL, et al. Antithrombotic therapy in patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention[J]. Circulation, 2018,138(5):527-536.
[5] Lopes RD, Heizer G, Aronson R, et al. Antithrombotic therapy after acute coronary syndrome or pci in atrial fibrillation[J]. N Engl J Med, 2019, 380(16):1509-1524.
[6] Golwala HB, Cannon CP, Steg PG, et al. Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of randomized clinical trials[J]. Eur Heart J, 2018,39(19):1726-1735.
[7] Schomig A, Neumann FJ, Kastrati A, et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents[J]. N Engl J Med, 1996,334(17):1084-1089.
[8] Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent anticoagulation restenosis study investigators[J]. N Engl J Med, 1998,339(23): 1665-1671.
[9] Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial[J]. Lancet, 2013,381(9872):1107-1115.
[10] January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J]. J Am Coll Cardiol, 2014,64(21):e1-e76.
[11] Gibson CM, Mehran R, Bode C, et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI[J]. N Engl J Med, 2016,375(25):2423-2434.
[12] Cannon CP, Bhatt DL, Oldgren J, et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation[J]. N Engl J Med, 2017,377(16): 1513-1524.
[13] Vranckx P, Lewalter T, Valgimigli M, et al. Evaluation of the safety and efficacy of an edoxaban-based antithrombotic regimen in patients with atrial fibrillation following successful percutaneous coronary intervention (PCI) with stent placement: Rationale and design of the ENTRUST-AF PCI trial[J]. Am Heart J, 2018,196:105-112.
[14] Lopes RD, Hong H, Harskamp RE, et al. Safety and efficacy of antithrombotic strategies in patients with atrial fibrillation undergoing percutaneous coronary intervention: a network meta-analysis of randomized controlled trials[J]. JAMA Cardiol, 2019,4(8):747-755.
[15] Wernly B,?Lichtenauer M,?Erlinge D, et al. Antithrombotic therapy in atrial fibrillation: stop triple therapy and start optimizing dual therapy?[J]. Clin Res Cardiol,2020,109(1):128-130.
[16] Haller PM, Sulzgruber P, Kaufmann C, et al. Bleeding and ischemic outcomes in patients treated with dual or triple antithrombotic therapy - systematic review and meta-analysis[J]. Eur Heart J Cardiovasc Pharmacother, 2019,5(4):226-236.
[17] Andreou I, Briasoulis A, Pappas C, et al. Ticagrelor versus clopidogrel as part of dual or triple antithrombotic therapy: a systematic review and meta-analysis[J]. Cardiovasc Drugs Ther, 2018,32(3):287-294.
[18] Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization[J]. Eur Heart J, 2019,40(2):87-165.
[19] Angiolillo DJ, Goodman SG, Bhatt DL, et al. Antithrombotic therapy in patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention[J]. Circulation, 2018,138(5):527-536.
[20] Gao F, Shen H, Wang ZJ, et al. Rationale and design of the RT-AF study: Combination of rivaroxaban and ticagrelor in patients with atrial fibrillation and coronary artery disease undergoing percutaneous coronary intervention[J]. Contemp Clin Trials, 2015,43:129-132.
[21] Lu W, Chen L, Wang Y, et al. Rationale and design of MANJUSRI trial: a randomized, open-label, active-controlled multicenter study to evaluate the safety of combined therapy with ticagrelor and warfarin in AF subjects after PCI-eS[J]. Contemp Clin Trials, 2015,40:166-171.
[22] Wustrow I, Sarafoff N, Haller B, et al. Real clinical experiences of dual versus triple antithrombotic therapy after percutaneous coronary intervention[J]. Catheter Cardiovasc Interv, 2018,92(7):1239-1246.
[23] van Rein N, Heide-Jorgensen U, Lijfering WM, et al. Major Bleeding rates in atrial fibrillation patients on single, dual, or triple antithrombotic therapy[J]. Circulation, 2019,139(6):775-786.
[24] Effron MB, Gibson CM. Dual (anticoagulant plus single antiplatelet) vs triple (anticoagulant plus dual antiplatelet) antithrombotic therapy - "real world" experience[J]. Prog Cardiovasc Dis, 2018,60(4-5):531-536.
[25] Xanthopoulou I, Dragona VM, Davlouros P, et al. Contemporary antithrombotic treatment in patients with non-valvular atrial fibrillation undergoing percutaneous coronary intervention: rationale and design of the greek antiplatelet atrial fibrillation (GRAPE-AF) Registry[J]. Cardiovasc Drugs Ther, 2018,32(2): 191-196.
[26] Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS)[J]. Eur Heart J, 2018,39(3):213-260.
[27] Fiedler KA, Maeng M, Mehilli J, et al. Duration of triple therapy in patients requiring oral anticoagulation after drug-eluting stent implantation: the ISAR-TRIPLE trial[J]. J Am Coll Cardiol, 2015,65(16):1619-1629.
[28] 刘静,刘恒亮.急性冠脉综合征合并心房颤动的抗栓策略[J].心血管病学进展,2018,39(2):282-286.
[29] Kearon C. In AF, ABC scores predicted stroke or major bleeding better than CHA2DS2-VASc and HAS-BLED scores, respectively[J]. Ann Intern Med, 2019,170(12):C71.
[30] Mantis C, Alexopoulos D. Antithrombotic treatment in atrial fibrillation patients undergoing PCI: Is dual therapy the winner?[J]. Thromb Res, 2019,176:133-139. 收稿日期:2019-06-27

备注/Memo

备注/Memo:
基金项目:湖北省教育厅科学技术研究项目基金(B2019027)
更新日期/Last Update: 2020-04-14