Comparison Of Different Antithrombotic Strategy In Atrial Fibrillation Patients Combining With Coronary Artery Disease After Percutaneous Coronary Intervention

Research background Atrial fibrillation and coronary heart disease are two common cardiovascular diseases,witch with similar high factors,such as age,obesity,diabetes,hypertension,hyperlipidemia,etc.So atrial fibrillation patients combining with coronary artery disease after percutaneous coronary intervention or in patients with acute coronary syndrome(ACS)is not uncommon in clinic,There are 5%to 8%of patients with coronary heart disease with atrial fibrillation,At the same time the incidence of atrial fibrillation in ACS was 2%-21%.While the atrial fibrillation patients combining with coronary artery disease after percutaneous coronary intervention(PCI),Which needs both dual antiplatelet therapy(DAPT)for P2Y12 receptor antagonists(such as:clopidogrel)and aspirin and anticoagulation with vitamin K antagonists(such as:warfarin)are required to prevent arteriovenous blood vessels and stents thrombosis can not be replaced because of the different pharmacological mechanisms of the two drugs,but the combined use of the two drugs will increase the risk of bleeding.Therefore,it is necessary to select a proper antithrombotic treatment program by comprehensively evaluating the risk of bleeding due to embolization and antithrombotic therapy.However,there are still controversies about the specific antithrombotic regimen after percutaneous coronary intervention in patients with atrial fibrillation and coronary heart disease.Objective Comparison of different in patients with atrial fibrillation(AF)complicated coronary heart disease(CHD)undergoing percutaneous coronary intervention(PCI).Methods A total of 90 AF+CAD patients undergoing PCI were divided into trigeminy antithrombotic therapy group[TT group,n=30],bigeminy antithrombotic therapy group[DT group,n=30]and 30 patients(WS group,n=30)discharged with warfarin and clopidogrel;Other secondary prevention was same in this groups.These patients were followed up for 12 months.Results Of all the selected patients,according to the proportion of CHA2DS2-VASc score and HAS-BLED score,indicating that the selected patients had higher risk of stroke and a considerable risk of bleeding,but there was no significant statistical difference.Patients with triple antithrombotic therapy had a significant reduction in stroke and major adverse cardiac and cerebral events(MACCE)(?~2=6.193,P=0.045),as compared with either DT or WS group,there was significant statistical difference.The results showed that there was a difference between TT group and DT group(x2=5.454,P=0.021)by Bonferroni method,but there was no statistical difference between the other two groups(P>0.05).Portantly,the incidence of major bleeding was comparable among three groups(x~2=0.000,P=1.000),although There was an increased risk of overall bleeding in TT group(?2=1.041,P=0.594),,there was no significant statistical difference,too.Conclusion For patients with atrial fibrillation complicated with coronary heart disease after PCI,the rate of ischemic stroke and MACCE in TT group was better than that in other group,and there was no difference between WS group and DT group.