用低分子肝素急性抗凝再用伊布利特或普罗帕酮复律治疗心房颤动/扑动患者多中心临床研究

Multicenter clinical trial on low molecular weight heparin acute anticoagulation before immediate conversion in the treatment of atrial fibrillation and atrial flutter

目的 评价发作持续48h余的房颤/房扑患者用低分子肝素急性抗凝后再用伊布利特与普罗帕酮复律的有效性及安全性。方法 共入选持续时间<90天的房扑/房颤患者212例(房颤151例,房扑61例),发作持续时间≥48h为试验组(51例), <48h为对照组(161例)。试验组经心脏超声除外血栓后,静推低分子肝素1. 7mg·kg-1行急性全身肝素化,对照组不抗凝治疗; 2组均于10min内静推伊布利特1mg或普罗帕酮70mg;给药结束10min后未复律者,重复给药1次。观察给药1. 5h内的转复率及4h内药物不良反应。结果 伊布利特对房扑的转复率明显高于房颤(78. 1% vs48. 3%,P<0. 01),对房颤的转复率、平均转复时间等, 2种药比较无显著性差异(P>0. 05)。试验组药物不良反应发生率无明显增加。结论 发作持续时间≥48h的房扑/房颤患者,用低分子肝素急性抗凝后再用伊布利特与普罗帕酮复律安全、有效。

Objective To evaluate the efficacy and safety of intravenous low molecular weight heparin (LMWH) for acute anticoagulation before immediate conversion of atrial fibrillation (AF) and atrial flutter (AFL) lasted more than 48 hours. Methods Two hundreds and twenty two patients with AF or AFL lasted less than 90 days were enrolled. One hundred and sixty one patients with AF/AFL lasted less than 48 hours were taken as control group, 51 patients with AF/AFL lasted more than 48 hours were taken as trial group.Echocardiography screening and intravenous LMWH 1.7mg·kg -1 were given for acute systemic heparinazation in trial group before antiarrhythmia drugs. Patient in control group give ibutilide or propafenone directly. Conversion rate within 1.5 hours and adverse effects within 4 hours were observed. Results Ibutilide had a significantly higher conversion rate on AFL than propafenone (78.1% vs 48.3%,P<0.01), while there was no significant difference on conversion of AF and mean conversion time (P>0.05). There was no significant difference on bleeding, embolus and other adverse effects between control and trial groups (P>0.05). Conclusion It was safe and effective of intravenous LMWH for acute anticoagulation before immediate converseon of atrial fibrillation (AF) and atrial flutter (AFL) lasted more than 48 hours by intravenous ibutilide or propafenone.