Enomoto Yoshinari, Iijima Raisuke, Tokue Masahide, Ito Naoshi, Nagashima Yoshinori, Araki Tadashi, Yamazaki Kenji, Utsunomiya Makoto, Hori Masaki, Itaya Hideki, Shiba Masanori, Hara Hidehiko, Nakamura Masato, Sugi Kaoru
Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
Cardiovasc Interv Ther. 2014 Jul;29(3):193-9. doi: 10.1007/s12928-013-0234-4. Epub 2013 Dec 24.
In the era of drug-eluting stents (DES), a long-term dual antiplatelet therapy is required to prevent late stent thrombosis. However, in patients with atrial fibrillation (AF), there is a concern that combining warfarin with dual antiplatelet therapy may increase the risk of bleeding. We analyzed 1274 consecutive patients with coronary artery disease who were treated with coronary intervention from January 2006 through January 2009. Of these, we enrolled 74 AF patients treated with DES and dual antiplatelet therapy as well as warfarin. The primary endpoint was the incidence of major bleeding within 3 years; the predictive factor of major bleeding was also analyzed. To evaluate the efficacy of anticoagulant therapy, time in therapeutic range (TTR) was also measured. The 3-year incidence of major bleeding was 12.2 % (nine of 74 patients). The average observation period was 25.7 ± 20.2 months. Mean TTR value was 44.6 ± 33.0 % and was maintained at a relatively low level. Multivariate analysis revealed that a higher CHADS2 score (2-point more) was an independent predictor of increased risk of major bleeding. Major bleeding in the patients with triple antithrombotic therapy including warfarin occurred at a relatively high rate. Although the higher CHADS2-score indicates a high risk of thrombotic events, it was strongly associated with bleeding complications.
在药物洗脱支架（DES）时代，需要长期双重抗血小板治疗以预防晚期支架血栓形成。然而，对于心房颤动（AF）患者，人们担心华法林与双重抗血小板治疗联合使用可能会增加出血风险。我们分析了2006年1月至2009年1月期间接受冠状动脉介入治疗的1274例连续性冠心病患者。其中，我们纳入了74例接受DES、双重抗血小板治疗以及华法林治疗的AF患者。主要终点是3年内大出血的发生率；还分析了大出血的预测因素。为了评估抗凝治疗的疗效，还测量了治疗范围内的时间（TTR）。大出血的3年发生率为12.2%（74例患者中有9例）。平均观察期为25.7±20.2个月。平均TTR值为44.6±33.0%，并维持在相对较低的水平。多变量分析显示，较高的CHADS2评分（高2分）是大出血风险增加的独立预测因素。包括华法林在内的三联抗栓治疗患者的大出血发生率相对较高。尽管较高的CHADS2评分表明血栓事件风险较高，但它与出血并发症密切相关。
