Pokorney Sean D, Rao Meena, Nilsson Kent R, Piccini Jonathan P
Duke Center for Atrial Fibrillation/Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center.
Claude D. Pepper Center Older American Independence Center.
J Atr Fibrillation. 2012 Oct 6;5(3):611. doi: 10.4022/jafib.611. eCollection 2012 Oct-Nov.
Atrial fibrillation frequently complicates myocardial infarction. Patients with atrial fibrillation complicating acute coronary syndrome have increased morbidity and mortality relative to patients that remain in normal sinus rhythm. No studies have identified a mortality benefit to rhythm control compared with rate control in the setting of acute coronary syndrome. Stroke prevention should be pursued with oral anticoagulation therapy, although the majority of patients with atrial fibrillation associated with acute coronary syndrome receive only antiplatelet therapy. There are several novel oral anticoagulant therapies now available, but these agents have not been well studied in combination with dual antiplatelet therapy. Therefore, warfarin as part of triple therapy is the most conservative approach until additional data becomes available.
心房颤动常使心肌梗死病情复杂化。与维持正常窦性心律的患者相比，伴有急性冠状动脉综合征的心房颤动患者的发病率和死亡率更高。在急性冠状动脉综合征的情况下，尚无研究表明节律控制比心率控制更能降低死亡率。应采用口服抗凝治疗来预防卒中，尽管大多数伴有急性冠状动脉综合征的心房颤动患者仅接受抗血小板治疗。目前有几种新型口服抗凝治疗药物，但这些药物与双联抗血小板治疗联合应用的研究还不够充分。因此，在获得更多数据之前，华法林作为三联治疗的一部分是最保守的方法。
