Effect of anticoagulant therapy for elderly patients with atrial fibrillation and stable coronary artery disease / 中华老年医学杂志

ABSTRACT

Objective To evaluate the effect of different anticoagulant therapy regimens in patients with atrial fibrillation and stable coronary artery disease.Methods This was a retrospective cohort study.Patients with coronary artery disease and atrial fibrillation undergoing percutaneous coronary intervention(PCI) in our hospital from January 2014 to January 2017 were involved.Based on the anticoagulant regimen,all patients were divided into two groups.dual antiplatelet anticoagulant group(treated with aspirin and clopidogrel,as DT group),warfarin and one antiplatelet drug group (treated with warfarin and aspirin,or warfarin and clopidogrel,as WS group).We compared the safety (risk of bleeding)and efficacy(major adverse cardiac and cerebrovascular event)between groups after 12-month follow-up.Results 329 patients were included,with 173 males and mean age of(70.1± 9.3)years.There were 82 patients in the DT group,and 247 patients in the WS group.Patients in the WS group were older,and with significantly higher rates of diabetes,higher levels of creatine kinase-MB(CK-MB)and thrombosis risk compared with WS group(all P＜0.05),though the anticoagulant duration,bleeding risk,data about coronary artery and peak value of CK-MB 24 h post-PCI were similar between groups.After(11.7 ± 1.5) months follow-up,the rates of bleeding was comparable between the two groups (P ＞ 0.05).The rates of major adverse cardiacand cerebrovascular events (MACCE)were similar between groups(P ＞0.05),though there was a trend of increased risk of ischemic stroke in the DT group.Conclusions For patients with coronary artery disease and atrial fibrillation undergoing PCI,dual antiplatelet therapy is a safe and effective anticoagulant regimen.However,there is a trend of increased rate of ischemic stroke,which is needed to explore.