Safety and efficacy of different antithrombotic therapy regimens for atrial fibrillation after percutaneous coronary intervention in elderly patients / 中华老年医学杂志

ABSTRACT

Objective To evaluate the short-term safety,efficacy and prognosis of different antithrombotic therapy regimens in elderly patients with atrial fibrillation after coronary artery stenting.Methods A total of 272 atrial fibrillation patients with 121 males and a mean age of(67.1 ±5.2)years undergoing coronary artery stenting in our hospital from January 2013 to December 2015 were retrospectively analyzed and rondomized into two antithrombotic therapy regimensa dual antiplatelet therapy with aspirin and clopidogrel(DT group,n=175)and a triple antithrombotic therapy with warfarin,aspirin and clopidogrel(TT group,n=97).The one-year risk of major bleeding and major adverse cardiac and cerebrovascular event (MACCE) were compared between two groups.Results After one year follow-up,the rate of major bleeding was lower in the DT group (0.6％,n=1)than in the TT group(5.2％,n=5)(x2 =5.92,P =0.01).Nevertheless,the rates of MACCE showed no statistical difference between two groups (all P ＞ 0.05).No statistically significant differences were found between DT group(n=175)and TT group(n=97)in six therapeutic efficacy indexes as the follow[n(％)in DT vs.n(％)in TT]in in-stent thrombosis[1 (0.6)in DT vs.0 (0.0) in TT],in myocardial infarction relapse [35 (20.0) in DT vs.17 (17.5) in TT],in revascularization once more[28(16.0)in DT vs.17(17.5)in TT],in death[7(4.0)in DT vs.3(3.1)in TT],in adverse cardiac cerebrovascular events[90 (51.4) in DT vs.45 (46.4) in TT],and in ischemic stroke[19(10.9) in DT vs.8 (8.2) in TT] (all P ＞ 0.05).However,the rate of atrial fibrillationinduced ischemic stroke may be increased in patients treated with DT of aspirin and clopidogrel as compared with TT of warfarin,aspirin and clopidogrel.Conclusions For atrial fibrillation after coronary artery stenting,triple antithrombotic treatment can lead to increased risks for major bleeding with similar rate of MACCE to dual antiplatelet therapy,but dual antiplatelet therapy may result in the raised rate of atrial fibrillation induced ischemic stroke.