目的：冠状动脉扩张（coronary artery ectasia, CAE）指扩张部分的冠脉直径超过周围正常血管的1.5倍，这是一种冠状动脉变异性疾病，临床十分罕见。CAE能独立导致主要不良心血管事件（major adverse cardiovascular events, MACE）上升，由于动脉扩张部分血流减慢，导致血栓形成风险高，容易造成栓塞及缺血事件。CAE目前尚无系统性治疗方法，尤其是抗栓药物选择，许多病例报道传统冠心病双抗血小板治疗不能有效控制病情，长期抗凝的必要性目前存在很多争议。利伐沙班是一种新型口服抗凝剂，较传统华法林相比具有不需严格INR监测、治疗窗较宽等优点。本研究采用利伐沙班作为干预手段，探究抗凝治疗是否有助于减少CAE患者的不良心血管事件，同时评估其出血风险，为CAE的抗栓治疗策略提供参考。

方法：本试验为单中心、前瞻性、探索性研究。筛选2021-2023年国家心血管病中心冠状动脉造影显示弥漫的冠状动脉扩张患者入组，估算样本量200人，收集患者的基线资料，受试者按照 1:1 随机分配至对照组与试验组。对照组根据临床合并症情况采用常规的抗血小板疗法，不包括抗凝药。试验组人员在常规疗法的基础上，加用利伐沙班片抗凝。每6个月随访一次，随访3年，评估患者MACE风险及出血事件风险。

结果：通过对已随访患者的终点事件进行分析，主要效应终点（MACE）总共8例（6.6%），其中对照组2例（3.3%），实验组6例 （9.7%），两组之间MACE风险没有显著差异（p=0.273），两组间MACE组成事件（再发非致死性心肌梗死、再次 PCI/CABG、心脏原因再住院）风险也无统计学差异。主要安全终点（出血事件）共19例（15.6%），其中对照组4例（6.7%），实验组 15 例（24.2%），相比于常规疗法组来说，实验组患者的主要大出血事件风险显著增加（p<0.05）。

结论：相比于以往个案报道及回顾性研究结论，本研究没有发现CAE患者在常规治疗基础上加用抗凝治疗有所获益，这可能与本研究入选样本量小有关，同时抗凝治疗带来出血风险增加需要引起重视，未来还需进行更大规模CAE患者抗凝治疗的有效性及安全性研究验证。

Objective：Coronary artery ectasia(CAE) means that the diameter of the abnormally dilated coronary artery is 1.5 times larger than that of the nearby normal blood vessels. Coronary angiography is the gold standard for diagnosis.CAE can independently lead to the increase of major adverse cardiovascular events (MACE), which may be related to slow blood flow of dilated segments, easy to form thrombus, and then lead to coronary artery spasm and microcirculation disturbance.At present, there is no systematic treatment for CAE, especially the choice of antithrombotic drugs. Many cases report that traditional double antiplatelet therapy can not effectively control the disease, and there is a lot of controversy about the necessity of long-term anticoagulation.Rivasaban is a new oral anticoagulant. Compared with traditional warfarin, rivasaban has the advantages of no strict INR monitoring and wide treatment window.In this study, rivasaban was used as an intervention to explore whether anticoagulant therapy helps to reduce adverse cardiovascular events in patients with CAE, and to evaluate the risk of bleeding, so as to provide reference for antithrombotic therapy for CAE.

Methods：This study is a single-center, prospective and exploratory study. The patients with diffuse coronary artery ectasia in Fuwai Hospital of Chinese Academy of Medical Sciences were selected into the group, and the sample size was estimated to be 200, which was expected to be included for half a year.The baseline data of the patients were collected and the subjects were randomly assigned to the control group and the experimental group at 1:1. The control group was treated with routine antiplatelet therapy according to clinical complications, excluding anticoagulants. On the basis of routine treatment, the experimental group was treated with rivasaban tablets for anticoagulation. The patients were followed up every 6 months for 3 years to assess the risk of MACE and bleeding events.

Results: Through the analysis of the end-point events of the patients who had been followed up, there were a total of 8 cases (6.6%) of the main effect endpoints (MACE), including 2 cases (3.3%) in the control group and 6 cases (9.7%) in the experimental group. There was no significant difference in MACE risk between the two groups (P=0.273). There was no statistical difference in the risk of MACE composition events (recurrent non-fatal myocardial infarction, re-PCI/CABG, re-hospitalization for cardiac reasons) between the two groups.The main safe end point (bleeding event) was 19 cases (15.6%), including 4 cases (6.7%) in the control group and 15 cases (24.2%) in the experimental group. Compared with the routine treatment group, the risk of bleeding events in the experimental group was significantly increased (P<0.05).

Conclusion: Compared with previous case reports and retrospective studies, this study did not find any benefit from anticoagulation therapy in patients with CAE on the basis of routine treatment, which may be related to the small number of samples selected in this study and the need to pay attention to the increased risk of bleeding caused by anticoagulation therapy. More studies on the effectiveness and safety of anticoagulation therapy in patients with CAE need to be conducted in the future.