阿司匹林联合双嘧达莫在非瓣膜性心房颤动患者抗栓治疗中的应用

发布时间：2018-08-30 20:04

【摘要】：目的:在不适合服用华法林的非瓣膜性心房颤动(NVAF)患者中,对比研究阿司匹林单药治疗与阿司匹林和双嘧达莫联合治疗的有效性(血栓栓塞事件风险)及安全性(出血事件发生率),为我国(特别是边远贫困地区)非瓣膜性房颤患者的抗凝治疗提供新依据。方法:选择于2012年7月至2014年5月在河北省第七人民医院心内科门诊及住院的非瓣膜性房颤患者,按照入选标准共选择198例CHADS2评分至少为1分的患者,随机分为2组:阿司匹林联合双嘧达莫(联合治疗组)给予阿司匹林(100mg,每日一次)+双嘧达莫(100mg,每日三次);阿司匹林组给予(100mg,每日一次)。门诊随访察两组血栓栓塞事件(缺血性脑卒中、外周动脉栓塞)、各种出血事件(颅内出血、胃肠道、泌尿系、皮肤黏膜等出血)及其他不良反应的发生率,并比较它们之间的差异性。结果:1 198例NVAF患者中联合治疗组96例,阿司匹林组102例。各组患者一般资料比较(包括合并疾病及用药)差异无统计学意义(P0.05)。2两组患者CHADS2评分比较差异无统计学意义(P0.05),平均CHADS2评分为2.7分。3随访时间10~20(12±6)个月。两组共脱落5例,其中联合治疗组脱落2例,阿司匹林组脱落3例。4联合治疗组发生缺血性脑卒中2例,周围动脉栓塞3例;阿司匹林组发生缺血性脑卒中9例,其中1例死亡,急性心肌梗死1例,周围动脉栓塞4例。联合治疗组缺血性脑卒中发生率明显低于阿司匹林组(2.1%比9.1%P=0.04),总缺血事件的发生率也明显低于阿司匹林组(5.3%比14.1%P=0.04),差异有统计学意义。5两组均无严重出血发生,联合治疗组发生轻微出血7例,阿司匹林组发生轻微出血4例,两组比较差异无统计学意义(7.4%比4.0%P=0.31)。6联合治疗组发生头痛11例,血小板减少1例,剑突下疼痛8例;阿司匹林组发生剑突下疼痛7例,以头痛为主的不良反应联合治疗组高于阿司匹林组,差异有统计学意义(21.3%比7.1%P=0.005)。结论:对于CHADS2评分≥1分的非瓣膜性房颤患者,阿司匹林联合双嘧达莫预防血栓栓塞事件安全有效,优于单纯口服阿司匹林。
[Abstract]:Objective: in patients with non-valvular atrial fibrillation (NVAF) who are not suitable for warfarin, A comparative study of the efficacy (thromboembolic event risk) and safety (haemorrhage incidence) of aspirin monotherapy with aspirin and dipyridamole, which is non-valvular in China (especially in remote poor areas) To provide a new basis for anticoagulant therapy in patients with atrial fibrillation. Methods: a total of 198 patients with non-valvular atrial fibrillation were selected from July 2012 to May 2014 in the Department of Cardiology, Hebei Province Seventh people's Hospital. According to the inclusion criteria, a total of 198 patients with CHADS2 score of at least 1 were selected. They were randomly divided into two groups: aspirin combined with dipyridamole (100 mg, once a day) and aspirin group (100 mg, once a day). The incidence of thromboembolism events (ischemic stroke, peripheral artery embolism), various bleeding events (intracranial hemorrhage, gastrointestinal bleeding, urinary tract bleeding, skin and mucous membrane bleeding) and other adverse reactions were observed during outpatient follow-up. And compare their differences. Results among 1 198 cases of NVAF, 96 cases were treated with combined therapy and 102 cases were treated with aspirin. There was no significant difference in CHADS2 score between the two groups (P0.05). The average CHADS2 score was 2.7 points. 3. The follow-up time was 1020 (12 卤6) months. There were 5 cases of abscission in both groups, 2 cases in combination group, 3 cases in aspirin group, 2 cases in ischemic stroke, 3 cases in peripheral artery embolism, 9 cases in aspirin group, 9 cases in aspirin group. One case died, one case had acute myocardial infarction and 4 cases had peripheral artery embolism. The incidence of ischemic stroke in the combined treatment group was significantly lower than that in the aspirin group (2.1% vs 9.1%P=0.04), and the incidence of total ischemic events was significantly lower than that in the aspirin group (5.3% vs 14.1%P=0.04). There were 7 cases of slight hemorrhage in the combined treatment group and 4 cases in the aspirin group. There was no significant difference between the two groups (7.4% vs 4.0%P=0.31) .6 in 11 cases of headache, 1 case of thrombocytopenia and 8 cases of subflagellate pain. There were 7 cases of subflagellate pain in aspirin group. The side effect of headache in combination group was higher than that in aspirin group (21.3% vs 7.1%P=0.005). Conclusion: aspirin combined with dipyridamole is safe and effective in preventing thromboembolic events in patients with non-valvular atrial fibrillation with CHADS2 score 鈮，

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