|本期目录/Table of Contents|

[1]周洪千,张煜坤,胡苏涛,等.口服抗凝剂与肝素对心房颤动的心肌梗死患者的安全性和有效性比较[J].天津医科大学学报,2025,31(04):376-381.[doi:10.20135/j.issn.1006-8147.2025.04.0376]
　ZHOU Hongqian,ZHANG Yukun,HU Sutao,et al.Comparative safety and efficacy of oral anticoagulant versus heparin in the treatment of myocardial infarction patients with atrial fibrillation[J].Journal of Tianjin Medical University,2025,31(04):376-381.[doi:10.20135/j.issn.1006-8147.2025.04.0376]
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口服抗凝剂与肝素对心房颤动的心肌梗死患者的安全性和有效性比较(PDF)

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:
31卷
期数:
2025年04期
页码:
376-381
栏目:
临床医学
出版日期:
2025-07-10

文章信息/Info

Title:
Comparative safety and efficacy of oral anticoagulant versus heparin in the treatment of myocardial infarction patients with atrial fibrillation
文章编号:
1006-8147(2025)04-0376-06
作者:
周洪千; 张煜坤; 胡苏涛; 顾天舒; 刘彤; 陈康寅
（天津市心血管病离子与分子机能重点实验室，天津医科大学第二医院心脏科，天津心脏病学研究所，天津300211）
Author(s):
ZHOU Hongqian;  ZHANG Yukun;  HU Sutao;  GU Tianshu;  LIU Tong;  CHEN Kangyin
（Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease， Department of Cardiology， Tianjin Institute of Cardiology， The Second Hospital of Tianjin Medical University， Tianjin 300211， China）
关键词:
心房颤动; 心肌梗死; 抗凝治疗
Keywords:
atrial fibrillation;  myocardial infarction;  anticoagulant therapy
分类号:
R541.7
DOI:
10.20135/j.issn.1006-8147.2025.04.0376
文献标志码:
A
摘要:
目的：比较直接口服抗凝剂（DOAC）和低分子肝素桥接治疗（BHT）在心肌梗死（MI）后接受心房颤动（AF）治疗的患者中的安全性和有效性。方法：数据来源于2010年1月至2024年3月中国天津82家医院的回顾性队列研究。根据住院期间的抗凝治疗方案，将患者分为DOAC组和BHT组，并采用倾向评分匹配（PSM）进行平衡。主要终点包括安全性终点（复发性MI、卒中）和有效性终点（主要出血定义为出血学术研究联盟3～5级出血）。次要终点包括全因死亡、主要不良心血管和脑血管事件（MACCE）以及净不良临床事件（NACE）。随访时间为3个月。结果：DOAC组在主要终点（包括安全性和有效性终点）方面不劣于BHT组。与BHT组相比，DOAC组缺血性卒中的风险比（HR）为1.14（95% CI： 0.34～3.78，P=0.828），MI的HR为1.16（95% CI： 0.29～4.65， P=0.523），主要出血的HR为1.76（95% CI： 0.92～3.37， P=1.000）。在次要终点中，BHT组的全因死亡率风险更高（HR为1.88， 95% CI： 1.01～3.50，P=0.045），而其他复合终点（MACCE和NACE）在两组间无显著差异。结论：在MI后3个月内，DOAC维持治疗策略与BHT桥接治疗策略在AF患者中具有相似的安全性和有效性，且降低了全因死亡发生风险。
Abstract:
Objective： To compare the safety and efficacy of direct oral anticoagulants（DOACs） versus low-molecular-weight heparin bridging therapy（BHT） in atrial fibrillation（AF） patients receiving post-myocardial infarction（MI） treatment. Methods： Data for this study were sourced from a retrospective cohort of 82 hospitals in Tianjin， China， from January 2010 to March 2024. The patients were classified into DOAC and BHT groups according to anticoagulant therapy during hospitalization. The patients were matched based on propensity score matching（PSM）. The primary outcomes included safety endpoints（recurrent MI，stroke） and effectiveness endpoints（major bleeding defined as Bleeding Academic Research Consortium type 3-5 bleeding）. The secondary outcomes included all-cause mortality， major adverse cardiovascular and cerebrovascular events（MACCE） and net adverse clinical events（NACE）. The follow-up time point was set at 3 months. Results： The DOAC group was not inferior to the BHT group in terms of primary outcomes， including safety endpoints and effectiveness endpoints. Hazard ratios（HR） of DOAC group incidence proportions was 1.14 （95% CI：0.34-3.78， P=0.828） for the ischemic stroke， 1.16 （95% CI： 0.29-4.65， P=0.523） for MI， and 1.76 （95% CI： 0.92-3.37，P=1.000） for major bleeding versus BHT group. In the secondary outcomes， BHT group showed a higher risk of all-cause mortality （HR=1.88，95% CI：1.01-3.50，P=0.045），with no significant differences observed in other composite outcomes（MACCE and NACE） between the groups. Conclusion： Over a 3-month post-MI period， the DOAC maintenance therapy strategy and BHT bridging therapy strategy have similar safety and efficacy in patients with AF， with a reduced risk of all-cause mortality.

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备注/Memo

备注/Memo:
基金项目:天津市卫生健康委员会科学技术项目（TJWJ2022MS009）
作者简介:周洪千（1999-），男，医师，硕士在读，研究方向：心血管内科；通信作者：陈康寅，E-mail：chenkangyin@vip.126.com。
更新日期/Last Update: 2025-07-10