关键词: 心房颤动, 心绞痛, 不稳定型, 达比加群酯, 替格瑞洛, 老年人, 治疗结果, 安全性

Abstract: Objective　To investigate the effectiveness and safety of dabigatran combined with ticagrelor in the treatment of elderly patients with atrial fibrillation and unstable angina but without revascularization.Methods　From February 2015 to February 2017，100 elderly patients with atrial fibrillation and unstable angina without revascularization were selected from The Fourth Center Clinical College of Tianjin Medical University.They were randomly divided into dabigatran group （n=50） and warfarin group （n=50），receiving oral administration of dabigatran （110 mg twice daily） combined with ticagrelor（90 mg twice daily），warfarin combined with ticagrelor〔warfarin dose could be adjusted for maintaining an international normalized ratio （INR） of 2.0-3.0〕，respectively，on the basis of the conventional treatment.Both groups were followed up for 1 year.Blood coagulation parameters measured at baseline，at the end of the 1st，3rd，and 12th months of treatment，and bleeding events and cardiovascular adverse events within the follow-up period were recorded.Results　There were significant differences in the overall mean values of prothrombin time （PT），INR，thrombin time （TT），activated partial thromboplastin time （APTT），fibrinogen （Fib），D-dimer between the two groups （P<0.05）．Mean values of PT，INR，TT，APTT differed significantly between the groups at different time points （P<0.05），but Fib and D-dimer did not （P>0.05）．Values of PT，INR and TT were affected by the interactive effect of treatment regimen and treatment duration （P<0.05）．The overall mean values of PT，INR，TT，APTT，Fib and D-dimer were similar in both groups at baseline （P>0.05），but after 1，3，and 12 months of treatment，the former 4 increased while the latter two increased significantly in dabigatran group （P<0.05）．There was no significant difference in the incidence of cardiovascular adverse events between dabigatran group and warfarin group 〔4.0% （2/50） vs 6.0% （3/50）；χ2<0.001，P=0.999〕 during the follow-up period.No serious bleeding event occurred in both groups，but the incidence of total bleeding events in dabigatran group was lower than that of the warfarin group （χ2=4.955，P=0.026）．Conclusion　Dabigatran combined with ticagrelor can effectively prevent thrombotic events in elderly patients with atrial fibrillation and unstable angina.Moreover，it has a lower incidence of bleeding events compared with warfarin in combination with ticagrelor，indicating that it has good safety.

Key words: Dabigatran, Angina unstable, Ticagrelor, Atrial fibrillation, Aged, Treatment outcome, Safety