达比加群酯在心房颤动患者经导管射频消融术围术期抗凝治疗中的安全性和有效性研究

Safety and Efficacy of Dabigatran in Anticoagulation Therapy in the Perioperative Period of Radiofrequency Catheter Ablation for Patients With Atrial Fibrillation

目的探讨达比加群酯在心房颤动(房颤)患者经导管射频消融术(RFCA)围术期抗凝治疗中的安全性和有效性。方法选取2014年6月—2015年9月,在首都医科大学附属北京天坛医院接受RFCA的房颤患者80例。采用随机数字表法,将其分为对照组38例和观察组42例。两组患者均行RFCA,对照组围术期采用华法林抗凝治疗,观察组采用达比加群酯抗凝治疗。术后随访3个月,记录并比较两组围术期并发症发生情况。结果两组性别、平均年龄、房颤类型、存在外周血管动脉粥样斑块比例、左心房前后径、左心室射血分数(LVEF)、内生肌酐清除率(CCr)、房颤患者卒中发生评分系统(CHA2DS2-Vasc)得分、合并症、既往有卒中史比例比较,差异无统计学意义(P>0.05)。随访至3个月时,两组均无卒中等血栓栓塞事件发生;两组联合终点事件发生率比较,差异无统计学意义(P>0.05)。结论达比加群酯在房颤患者RFCA围术期抗凝治疗中的有效性和安全性均不低于华法林,可作为安全、稳定的RFCA围术期抗凝治疗策略。

Objective To explore the safety and efficacy of dabigatran in anticoagulation therapy in the perioperative period of radiofrequency catheter ablation（ RFCA） for patients with atrial fibrillation（ AF）. Methods From June 2014 to September 2015, we enrolled 80 AF patients who received RFCA in Beijing Tian Tan Hospital affiliated to Capital Medical University. By random number table method,the patients were divided into control group（ n = 38） and observation group（ n= 42）. The two groups were administrated by RFCA,control group was administrated by warfarin in anticoagulation therapy in the perioperative period, and observation group was administrated by dabigatran in anticoagulation therapy. After 3- month postoperative follow- up,the occurrence of complications in the perioperative period was recorded and compared between the two groups. Results There were no significant differences in gender,average age,AF types,the proportion of patients with artery atheromatous plaque in peripheral vessel,the anterior and posterior diameters of the left atrium,LVEF,CCr,CHA2DS2- Vasc score,complications,and the proportion of patients with stroke history between the two groups（ P〈0. 05）. After 3- month follow- up, no thromboembolic events like stroke occurred in the patients of the two groups, and the two groups were not significantly different in the incidence rate of composite endpoint event（ P〉0. 05）. Conclusion Dabigatran is as effective and safe as warfarin in the anticoagulation therapy in the perioperative period of RFCA for AF patients,thus it can be used as a safe and stable strategy.