Effects of triple antithrombotic therapy on atrial fibrillation patients with coronary artery disease after percutane-ous coronary intervention and analysis of influencing factors for major adverse cardiovascular events

YAN Zeng-qiang; DU Rong-sheng; LU Lin-feng; SUN Yu-cui; ZHANG Biao

doi:10.13820/j.cnki.gdyx.20240613

Abstract：Objective To evaluate the efficacy of a triple antithrombotic regimen(warfarin,aspirin,and clopi-dogrel)in patients with atrial fibrillation(AF)and coronary artery disease(CAD)undergoing percutaneous coronary in-tervention(PCI)and investigate the factors influencing bleeding events in these patients after PCI.Methods Clinical data from 105 AF patients with CAD who received PCI from January 2020 to January 2022 were collected.Patients were divided into three groups based on their post-PCI antithrombotic regimen:the triple therapy group(37 cases on warfarin,aspirin,and clopidogrel),the AC group(35 cases on aspirin and clopidogrel),and the WC group(33 cases on warfarin and clopidogrel).Over a 12-month follow-up,coagulation parameters,including prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),and fibrinogen(Fib),incidence of major adverse cardiovas-cular events(MACE),and bleeding events were compared across groups,and the factors influencing bleeding events were analyzed.Results Post-treatment,PT,TT,and APTT significantly increased,while Fib levels decreased in all groups(P＜0.01);however,no significant differences were observed among the groups for PT,TT,APTT,or Fib values after treatment(P＞0.05).The incidence of MACE was 2.7％in the triple therapy group,17.1％in the AC group,and 18.2％in the WC group,with no significant difference between groups(P＞0.05).In terms of bleeding events,no ma-jor bleeding occurred in the AC or WC groups;minor bleeding events occurred in 8.57％and 6.06％of cases,respec-tively.In the triple therapy group,the major bleeding rate was 5.41％,with minor bleeding at 13.51％,totaling 18.92％,with no significant difference between groups(x2=2.906,P=0.231).Age and HAS-BLED scores were sig-nificantly different between the bleeding and non-bleeding groups(P＜0.05),with the bleeding group being older(76.76±3.47)years than the non-bleeding group(59.62±3.33)years.Additionally,100％of the bleeding group had a HAS-BLED score≥3,compared to 31.1％in the non-bleeding group(P＜0.05).Logistic regression analysis,using age and HAS-BLED scores as independent variables,indicated that age(OR=1.085,95％CI:1.004-1.173,P=0.040)and HAS-BLED score(OR=4.984,95％CI:1.188-20.902,P=0.028)were independent risk factors for bleeding after PCI.Conclusion The triple antithrombotic therapy regimen of warfarin,aspirin,and clopidogrel can effectively improve hypercoagulability and reduce thrombotic risk in AF patients with CAD after PCI.Age and HAS-BLED score are independent risk factors for post-PCI bleeding events in these patients.Risk assessment is essential in choosing postoperative antithrombotic therapy to improve treatment safety.