心房颤动导管射频消融术桥接使用磺达肝癸钠或低分子肝素的临床结局(英文)

Clinical outcomes of bridging therapy with fondaparinux versus low-molecular-weight heparin in patients undergoing atrial fibrillation ablation

目的比较心房颤动消融桥接治疗使用磺达肝癸钠与低分子肝素两者的安全陛及有效眭。方法对2009年1月～2013年7月接受射频消融术的房颤患者进行分析。患者在术前停用华法林5d，皮下注射磺达肝癸钠或低分子肝素的桥接治疗直到至消融后国际标准化比值为2．0～3．0。对两组患者术后抗凝相关并发症进行比较。并发症识别和归类为血栓栓塞和出血事件。结果共有465名患者，68％的男性，年龄52．3＋15（25～80）岁参加了这项研究。磺达肝癸钠组纳入265名患者，低分子肝素组纳入200名患者。在磺达肝癸钠组观察到3例抗凝相关并发症，而低分子肝素组有13例（P=0．002），但是血栓栓塞方面两组无统计学差异（P=0．111）。在磺达肝癸钠组有2例出血并发症，低分子肝素组有8例（P=0．039）。随访观察3个月两组均没有心血管死亡病例。结论房颤导管消融期间使用磺达肝癸钠作为桥接治疗与低分子肝素相比，血栓栓塞并发症的风险无统计学差异，但略减少出血风险。磺达肝癸钠在房颤患者导管消融围手术期抗凝管理方面是安全有效的。

Objective To compare the efficacy and safety of bridging therapy with fondaparinux versus low-molecular-weight heparin （LMWH） in patients undergoing radiofrequency ablation for atrial fibrillation （A.F）. Methods AF patients undergoing radiofrequency ablation between January, 2009 and June, 2013 in Nanfang Hospital were analyzed. The patients received subcutaneous injection of either fondaparinux or LMWH as a bridging therapy during warfarin discontinuation 5 days before the ablation until a post-ablation international normalized ratio （INR） of 2.0-3.0 was achieved. Anticoagulant-related complications, identified and classified as thromboembolic and bleeding events, were compared between the two groups. Results A total of 465 patients （68% male; mean age 52.3_＋15 years, range 25 to 80 years） were enrolled in the study, including 265 in fondaparinux group and 200 in LMWH group. Anticoagulafion-related complications were observed in 3 patients in fondaparinux group, as compared with 13 in LMWH group （P=0.002）, but the thromboembolic rate did not differ significantly between the two groups （P--0.111）. Two patients in fondaparinux group and 8 in LMWH group showed bleeding complications （P=0.039）. No cardiovascular death occwrred in these patients during a mean follow-up period of 3 months. Conclusions Fondaparinux as the bridging therapy during catheter ablation for AF does not increase the risk of thromboembolic complications but slightly reduces the risk of bleeding compared to LMWH, suggesting its safety and effectiveness for periprocedural anticoagulation management in AF patients undergoing radiofrequency ablation.