Moustafa Abdelmoniem, Ruzieh Mohammad, Eltahawy Ehab, Karim Saima
Department of Internal Medicine and Cardiology, University of Toledo Medical Center, Toledo, Ohio, USA.
Avicenna J Med. 2019 Oct 3;9(4):123-128. doi: 10.4103/ajm.AJM_73_19. eCollection 2019 Oct-Dec.
Atrial fibrillation and coronary artery disease are commonly coexisting conditions that necessitate the use of an oral anticoagulant as well as dual antiplatelet therapy. Commonly referred to as triple oral antithrombotic therapy (TT), this helps prevent ischemic stroke and myocardial infarction but comes at the expense of an increased risk of bleeding. There is a growing body of evidence that the omission of aspirin from TT has the same preventive efficacy in terms of major adverse cardiacvascular and cerebrovascular events (MACCE) with significantly lower bleeding events. The combination of antiplatelet agents and direct oral anticoagulants (DOAC) is a matter of ongoing research. However, initial studies showed favorable safety profile of DOAC over vitamin K antagonist in combination with antiplatelet agents.
心房颤动和冠状动脉疾病是常见的并存病症，需要使用口服抗凝剂以及双重抗血小板治疗。这种治疗通常被称为三联口服抗栓治疗（TT），有助于预防缺血性中风和心肌梗死，但代价是出血风险增加。越来越多的证据表明，在三联口服抗栓治疗中省略阿司匹林，在主要不良心脑血管事件（MACCE）方面具有相同的预防效果，且出血事件显著减少。抗血小板药物与直接口服抗凝剂（DOAC）的联合应用仍是一个正在研究的问题。然而，初步研究表明，在与抗血小板药物联合使用时，DOAC的安全性优于维生素K拮抗剂。
