二尖瓣狭窄并发房颤行球囊成形术前抗凝与不抗凝的比较

Comparison between anticoagulation and non-anticoagulation in patients with atrial fibrillation secondary to mitral stenosis before percutaneous balloon mitral valvuloplasty

目的 :评价二尖瓣狭窄并发房颤患者行经皮二尖瓣球囊成形术 (PBMV)前是否需要常规抗凝治疗。方法 :风湿性心脏病二尖瓣狭窄并发房颤患者 2 5 1例 ,按就诊先后随机分为 A(n=12 6 ) ,B(n=12 5 )两组。控制心力衰竭后行PBMV。A组术前不使用任何抗凝药物及抗血小板药物 ,B组术前常规给予肝素、肠溶阿斯匹林及华法令抗凝 ,观察PBMV术中及术后 3d有无与 PBMV相关的体循环栓塞并发症。结果 :两组患者 PBMV均获成功 ,术中及术后均无栓塞并发症发生 ,术后血流动力学指标、心功能、二尖瓣口面积、心脏杂音均有明显改善 (P<0 .0 1)。结论 :二尖瓣狭窄并发房颤患者如既往无体循环栓塞史 ,左心房无附壁血栓 ,行 PBMV前并不需苛求常规抗凝。

AIM:To evaluate whether or not the regular anticoagulation therapy are needed before percutaneous balloon mitral valvuloplasty (PBMV) in patients with atrial fibrillation (AF) secondary to mitral stenosis. METHODS:251 patients with AF secondary to mitral stenosis were divided into group A( n =126) and group B ( n =125). No drugs of anticoagulation and antiplatelet were used in group A and heparin,aspirin and warfarin were used in group B before PBMV. Observed whether the systemic thromboembolism occured or not during and after PBMV. RESULTS:No systemic embolism occured during and after PBMV in both group A and group B. The parameters of hemodynamics, mitral valve area and cardiac function improved markedly ( P <0 01). CONCLUSION:Anticoagulation treatment wasn't needed in patients with AF secondary to mitral stenosis before PBMV if they hadn't the history of systemic thromboembolism and left atrial thrombus.