摘要
目的观察利伐沙班联合抗血小板药物(阿司匹林、氯吡格雷)治疗急性心肌梗死(AMI)后左心室血栓形成(LVT)的临床疗效与安全性。方法选择2017年2月—2018年2月武汉大学人民医院各院区收治入院及心内科门诊就诊的AMI合并左心室血栓患者44例作为研究对象,随机数字表法分为双重抗血小板治疗组(DAPT组)22例和三联抗血小板治疗组(TAPT组)22例;DAPT组给予利伐沙班(10 mg/d)联合氯吡格雷(75 mg/d)治疗;TAPT组在前者基础上加用阿司匹林肠溶片(100 mg/d)治疗,比较2组患者在治疗3个月内的血栓消失例数、血栓消失时间、凝血指标变化情况、新发血栓栓塞和出血事件发生情况。结果 2组患者在血栓消失例数、血栓消失时间、新发血栓栓塞事件发生情况、凝血指标变化比较差异均无统计学意义(P> 0. 05),而TAPT组出血事件多于DAPT组(χ~2=5. 939,P=0. 015),且2组患者出血事件主要以消化道出血最多见。结论利伐沙班联合抗血小板药物用于AMI合并左心室血栓的治疗在短期内安全有效,并且在联合利伐沙班和氯吡格雷治疗基础上加用阿司匹林治疗,未能明显增加临床疗效,同时使临床出血事件发生率增加。
Objective To investigate the clinical efficacy and safety of conventional therapeutic dose of rivaroxaban combined with antiplatelet drugs （aspirin, clopidogrel） on the treatment of left ventricular thrombus （LVT） after acute myocardial infarction （AMI）,and provide reference for clinical treatment of rivaroxaban. Methods Thirty patients with LVT after AMI who were admitted to the hospital and the cardiology outpatient department of Renmin Hospital of Wuhan University from February 2017 to February 2018 were selected as the research subjects. The patients were randomly divided into DAPT group and TAPT group, with 22 cases in each group. DAPT group was given rivaroxaban （ 10 mg/day） combined with clopidogrel （75 mg/day）, TAPT group was treated with aspirin enteric-coated tablets （100 mg/day） on the basis of the former, comparing the number of cases of thrombus disappearance, thrombus remission time, changes in coagulation parameters, new thromboembolic events and bleeding events within 3 months after treatment in the two groups. Results There was no significant difference in the number of cases of thrombosis disappeared, the time of thrombus disappearing, the incidence of new thromboembolic events and the changes in coagulation parameters between the two groups （χ^2/ P =0.611/0.434, χ^2/ P =-0.370/ 0.741 , χ^2/ P =0.226/0.635）. There was more bleeding in the TAPT group than in the DAPT group. The differences were statistically significant （χ^2/5.939, P =0.015）, and the most common bleeding events in the two groups were gastrointestinal bleeding. Conclusion The use of rivaroxaban combined with antiplatelet drugs for the treatment of AMI with LVT is safe and effective in short term, and aspirin treatment based on the combination of rivaroxaban and clopidogrel failed to significantly increase clinical efficacy, but increase the incidence of clinical bleeding events.
作者
全力力
黎明江
黄亚敏
易欣
QUAN Lili;LI Mingjiang;HUANG Yamin;YI Xin(Department of Cardiology,Renmin Hospital of Wuhan University,Key Laboratory of Cardiovascular Disease of Hubei Province,Wuhan 430060,China)
出处
《疑难病杂志》
CAS
2018年第10期1085-1088,1098,共5页
Chinese Journal of Difficult and Complicated Cases
基金
国家自然科学基金青年科学基金项目(81700249)
关键词
利伐沙班
心肌梗死
急性
左心室血栓
疗效
安全性
Rivaroxaban
Myocardial infarction
acute
Left ventricular thrombus
Efficacy
Safety
