非维生素K拮抗口服抗凝药物在心房颤动导管消融围术期应用安全性及有效性

The safety and efficacy of perioperative anticoagulant therapy with non vitamin-K oral anticoagulants in patients with atrial fibrillation underwent catheter ablation

目的评估非维生素K拮抗口服抗凝药物(NOACs)达比加群酯和利伐沙班在心房颤动患者导管消融围术期应用的安全性及有效性。方法选取自2012年1月至2017年12月于北部战区总医院行心房颤动导管消融术后应用NOACs的1570例患者为研究对象。应用达比加群酯者1009例,其中,应用达比加群酯150 mg者602例,应用达比加群酯110 mg者407例;应用利伐沙班20 mg或10 mg者561例。分析围术期应用不同NOACs的安全性及有效性。结果所有患者术后3个月内均无症状性脑梗死发生,无体循环栓塞及死亡。55例(3.50%)患者出现出血事件。5例(0.32%)出现国际血栓与止血学会(ISTH)大出血,其中,1例为脑出血,3例为消化道出血并接受输血治疗,1例为术中房间隔穿刺时发生心包压塞行外科手术。50例(3.18%)出现ISTH小出血,其中,6例便血,30例牙龈出血,3例血尿,4例鼻出血,2例眼结膜出血,3例皮肤出血及瘀斑,2例咳痰带血丝。倾向性评分匹配后,达比加群酯组与利伐沙班组的用药安全性比较,差异均无统计学意义(P>0.05)。结论达比加群酯及利伐沙班在心房颤动导管消融术后抗凝治疗过程中均有确切的有效性和安全性。

Objective To evaluate the safety and efficacy of non-vitamin K antagonist oral anticoagulants(NOACs)dabigatran and rivaroxaban in perioperative catheter ablation in patients with atrial fibrillation.Methods A total of 1570 patients with atrial fibrillation who underwent catheter ablation in General Hospital of Northern Theater Command from January 2012 to December 2017 were selected as the study subjects.A total of 1009 patients were treated with dabigatran,of which 602 patients were treated with dabigatran 150 mg and 407 patients were treated with dabigatran 110 mg.Another 561 patients received rivaroxaban 20 mg or 10 mg.To analyze the safety and efficacy of different NOACs in perioperative period.Results No symptomatic cerebral infarction,systemic circulation embolism or death occurred in all patients within 3 months after operation.Bleeding events occurred in 55 patients(3.50%).Five patients(0.32%)had massive International Society of Thrombosis and Haemostasis(ISTH)hemorrhage,including 1 patient with intracerebral hemorrhage,3 patients with gastrointestinal hemorrhage and receiving blood transfusion,and 1 patient with pericardial tamponade during intraoperative atrial septal puncture.Fifty cases(3.18%)had ISTH minor hemorrhage,including 6 cases of hematochezia,30 cases of gingival hemorrhage,3 cases of hematuria,4 cases of nosebleed,2 cases of conjunctival hemorrhage,3 cases of skin hemorrhage and ecchymosis,and 2 cases of bloody sputum.After matching propensity score,there was no statistical significance in drug safety between dabigatran group and rivaroxaban group(P>0.05).Conclusion Both dabigatran and rivaroxaban have proven efficacy and safety in anticoagulant therapy after catheter ablation of atrial fibrillation.