Internal and Cardiovascular Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
Intern Emerg Med. 2010 Aug;5(4):281-90. doi: 10.1007/s11739-010-0349-x. Epub 2010 Feb 11.
Combined antiplatelet and anticoagulant therapy has been suggested for those clinical conditions in which conventional antithrombotic regimens have shown suboptimal efficacy, and in patients with indication for both: antiplatelet and anticoagulant therapy. Clinical trials aimed at assessing the clinical benefit of the association with respect to mono-therapy have been conducted in patients with atrial fibrillation, in patients with recent myocardial infarction, and in patients with prosthetic heart valves. Overall, a favorable benefit-risk profile of combined therapy in comparison to anticoagulant alone has been observed in patients with mechanical prosthetic heart valves and in those with coronary artery disease while no clear advantage has been shown in patients with atrial fibrillation. In almost all these studies, however, a higher risk of major bleeding has been observed in patients receiving combined therapy in comparison to patients receiving warfarin alone. Thus, a combined regimen of anticoagulant and antiplatelet therapy should be reserved for selected patients at high risk of thromboembolic events who have a low risk of bleeding.
联合抗血小板和抗凝治疗已被建议用于那些常规抗血栓治疗方案显示疗效不佳的临床情况，以及那些同时需要抗血小板和抗凝治疗的患者。已经在房颤患者、近期心肌梗死患者和人工心脏瓣膜患者中进行了旨在评估联合治疗相对于单药治疗的临床获益的临床试验。总体而言，与单独抗凝相比，联合治疗在机械性人工心脏瓣膜患者和冠心病患者中的获益风险比更为有利，而在房颤患者中则没有明显优势。然而，在几乎所有这些研究中，与单独接受华法林治疗的患者相比，接受联合治疗的患者大出血风险更高。因此，抗凝和抗血小板联合治疗方案应保留给那些血栓栓塞事件风险高且出血风险低的高危患者。
