病人服用口服抗血栓藥物治療心房顫動合併冠狀動脈支架置放術的效果及安全性

Efficacy and Safety of Oral Antithrombotic Therapy in Atrial Fibrillation and Coronary Artery Stenting

洪智中(Chih-Chung Hung) ； 項怡平(Yi-Ping Hsiang) ； 簡麗卿(Li-Ching Chien)

《臺灣臨床藥學雜誌》 24卷4期 (2016/12) Pp. 317-327

https://doi.org/10.6168/FJCP.2016.2404.07

摘要

目的：針對使用抗凝血劑之心房顫動病人，發生急性心肌梗塞給予治療後，瞭解後續不同抗血栓藥物治療策略的療效及安全性。方法：以病歷回溯方式，納入自2004 ~ 2012 年心房顫動服用口服抗凝血劑病人，並於本院進行PCI 治療後，給予抗血栓藥物治療。結果： 研究分析後發現， 使用warfarin、clopidogrel 或aspirin 其中兩種藥物治療 (OR = -2.21, 95% CI 0.02 ~ 0.55, p = 0.007) 或使用warfarin、clopidogrel 或aspirin 單一藥物治療(OR = -1.84, 95% CI 0.03 ~ 0.79, p = 0.025) 發生栓塞相較於warfarin、clopidogrel 合併aspirin 三種藥物治療低；在出血併發症部分，不論是採用兩種藥物治療(OR = -0.54, 95% CI 0.07 ~ 5.2, p = 0.629) 或單一藥物治療(OR =-1.17, 95% CI 0.03 ~ 3.01, p = 0.312)，相較於三種藥物治療並無統計學上差異。結論：經本研究結果發現，在栓塞事件預防上，雖然結果顯示使用單一藥物或兩種藥物治療後，其效果並不亞於三種藥物治療，但由於三種藥物治療組人數過少，與其他兩組相差懸殊，雖然結果具有統計學上差異，但可信度不高；在安全性上各種藥物組合發生出血併發症無差異。近期美國、歐洲、澳洲等心臟學會陸續提出三種藥物治療方式，因此相關治療方式及研究才陸續被提出。未來仍需仰賴更多使用三種藥物治療經驗的研究來佐證抗凝血藥與抗血小板藥合併使用的利與弊。

關鍵字

心房顫動 ； 急性冠心症 ； 抗血栓藥物 ； 安全性

並列摘要

Objective: The study was evaluate the efficacy and safety of different mechanism of anti-thrombotic agents. Methods: The retrospective cohort study were included patients administered oral anti-coagulants post PCI treatment from 2004 ~ 2012. Results: The study was shown the incidence of thromboembolic events were lower in double combination therapy of warfarin and clopidogrel or aspirin (OR = -2.21, 95% CI 0.02 ~ 0.55, p = 0.007) or mono-therapy of warfarin or clopidogrel or aspirin (OR = -1.84, 95% CI 0.03 ~ 0.79, p = 0.025) compared to triple combination therapy of warfarin and clopidogrel and aspirin. However, no statistical significant differences were obtained between groups in risks of bleeding. (mono-therapy, OR = -1.17, 95% CI 0.03 ~ 3.01, p = 0.312; duo-therapy, OR = -0.54, 95% CI 0.07 ~ 5.2, p = 0.629). Conclusions: The results of our study shown in the prevention of thromboembolic events, the effect of single or combination therapy, no less than triple drug therapy; but because of the number of triple drug treatment group is too small, the credibility is not high and no difference in the occurrence of bleeding complications of our study. Recently the United States, Europe, Australia and other Heart Association have made triple drug therapy approach and have gradually been proposed. In the future, we need more evidences of advantages and disadvantages of triple therapy anticoagulants and antiplatelet.

並列關鍵字

Atrial Fibrillation ； Acute Coronary Syndrome ； Antithrombotic Agent ； Safety