华法林、阿司匹林、氯吡格雷三联治疗心房颤动患者的效果及对凝血因子的影响

doi:10.3760/cma.j.cn441417-20241216-12020

摘要/Abstract

摘要：

目的　分析华法林、阿司匹林、氯吡格雷三联治疗心房颤动（atrial fibrillation，AF）患者的效果及对凝血因子的影响。方法　选取2023年8月至2024年8月咸阳市中心医院收治的AF患者104例为研究对象。其中，59例采用阿司匹林联合氯吡格雷治疗，设为对照组；另45例采用华法林、阿司匹林、氯吡格雷三联治疗，设为观察组。对照组男34例，女25例，年龄（64.39±6.48）岁。观察组男29例，女16例，年龄（63.82±4.61）岁。比较两组治疗前后凝血功能、血管内皮功能，并以房颤血栓危险度评分［Congestive Heart Failure，Hypertension，Age≥75 years，Diabetes Mellitus，Stroke（doubled），Vascular Disease，Age 65-74，Sex Category，CHADS2-VASc］和房颤出血评分（Hypertension and Other Bleeding Risk Factors，HAS-BLED）评估患者血管栓塞及出血风险。统计两组治疗过程中主要心血管不良事件（major adverse cardiovascular events，MACE），使用logistic回归分析其相关因素。采用χ2检验和t检验进行统计分析。结果　观察组总有效率高于对照组［93.33%（42/45）比79.66%（47/59），P<0.05］。治疗后，观察组凝血酶原时间（prothrombin time，PT）、活化部分凝血活酶时间（activated partial thromboplastin time，APTT）、D-二聚体（D-dimer，D-D）水平、凝血酶时间（thrombin time，TT）均低于对照组（均P<0.05），且血管内皮功能更好。两组治疗后CHADS2-VASc、HAS-BLED评分均降低（均P<0.05），但组间差异无统计学意义（均P>0.05）。两组MACE发生率差异无统计学意义（P>0.05）。logistic回归分析显示，年龄、HAS-BLED评分均是影响MACE的独立危险因素（均P<0.05）。结论　华法林三联疗法可以有效调节AF患者的凝血功能与血管内皮功能，同时具有较高的安全性。

关键词: 心房颤动, 阿司匹林, 氯吡格雷, 凝血功能, 血管内皮功能

Abstract:

Objective　To analyze the effect of warfarin, aspirin, and clopidogrel for patients with atrial fibrillation (AF) and its influence on coagulation factors. Methods　One hundred and four patients with AF treated at Xianyang Central Hospital from August 2023 to August 2024 were selected as the study objects. Among which, 59 cases were treated with aspirin and clopidogrel, and were set as a control group; the other 45 cases were treated with warfarin, aspirin, and clopidogrel, and were set as an observation group. There were 34 males and 25 females in the control group; they were (64.39±6.48) years old. There were 29 males and 16 females in the observation group; they were (63.82±4.61) years old. The total effective rates and coagulation function and vascular endothelial function before and after the treatment were compared between the two groups. The risk of vascular embolism and bleeding of the patients was assessed by the Congestive Heart Failure, Hypertension, Age≥75 years, Diabetes Mellitus, Stroke (doubled), Vascular Disease, Age 65-74, Sex Category (CHADS2-VASc) and Hypertension and Other Bleeding Risk Factors (HAS-BLED). The major adverse cardiovascular events (MACE) were counted during the treatment in both groups, and the related factors were analyzed using the logistic regression analysis. χ² and t tests were used for the statistical analysis. Results　The total effective rate in the observation group was higher than that in the control group [93.33% (42/45) vs. 79.66% (47/59); P<0.05]. After the treatment, the prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer (D-D) level, and thrombin time (TT) of the observation group were lower than those of the control group (all P<0.05), and the vascular endothelial function was better. The scores of CHADS2-VASc and HAS-BLED were lower after than before the treatment in both groups (all P<0.05), but there were no statistical differences between the two groups (both P>0.05). There was no statistical difference in the incidence rate of MACE between the two groups (P>0.05). The logistic regression analysis showed that age and HAS-BLED score were the independent risk factors for MACE (both P<0.05). Conclusion　Warfarin triple therapy can effectively regulate the coagulation function and vascular endothelial function of patients with AF, and has high safety.

Key words: Atrial fibrillation, , Aspirin, , Clopidogrel, , Coagulation function, , Vascular endothelial function

徐丹赵莹高亭. 华法林、阿司匹林、氯吡格雷三联治疗心房颤动患者的效果及对凝血因子的影响 [J]. 国际医药卫生导报, 2025, 31(12): 2027-2032.

Xu Dan, Zhao Ying, Gao Ting.

Effect of warfarin, aspirin, and clopidogrel for patients with atrial fibrillation and its influence on coagulation factors [J]. International Medicine and Health Guidance News, 2025, 31(12): 2027-2032.

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