达比加群、华法林分别用于心房颤动患者射频消融术后疗效与安全性的比较

Comparison of the Efficacy and Safety of Dabigatran and Warfarin Respectively Used in Atrial Fibrillation Patients after Radiofrequency Ablation

目的:比较达比加群、华法林用于心房颤动患者射频消融术(RFCA)后的疗效和安全性。方法:回顾性分析141例非瓣膜性心房颤动并拟行RFCA患者资料,按用药的不同分为华法林组(71例)和达比加群组(70例)。华法林组患者入院前曾服华法林者入院后需停用,改为低分子肝素钙注射液100 U/kg,皮下注射,待INR<1.5时行RFCA,术前12 h停用低分子肝素钙注射液;术中静脉注射肝素钙注射液100 U/kg;术后4~6 h口服华法林钠片4.5 mg,每日1次,同时与低分子肝素桥接重叠治疗至少3~5 d;术后每3 d监测1次国际标准化比值(INR),维持INR 2.0~3.0,至少服用华法林3个月。达比加群组患者入院后停用曾服用的抗凝药物,改为口服达比加群酯胶囊110 mg(年龄≥70岁或体质量<60 kg)或150 mg(年龄<70岁或体质量≥60 kg),每日2次;术前24 h停用达比加群酯胶囊,术中用药同华法林组;术后6 h口服达比加群酯胶囊,至少服用3个月。观察两组患者术后第1、3个月总死亡率、脑卒中(短暂性脑缺血,缺血性脑病)发生率、外周血管栓塞率及出血情况。结果:两组患者术后第1、3个月总死亡率、脑卒中发生率、外周血管栓塞率、出血发生率比较,差异均无统计学意义(P>0.05)。结论:达比加群用于非瓣膜性心房颤动患者RFCA的抗凝疗效和安全性均与华法林相当。

OBJECTIVE：To compare the efficacy and safety of dabigatran and warfarin respectively used in atrial fibrillation patients after radiofrequency ablation（RFCA）. METHODS：Data of 141 nonvalvular atrial fibrillation patients,who scheduled for RFCA,were retrospectively analyzed and divided into warfarin group（71 cases）and dabigatran group（70 cases）by different med-ication. Patients in warfarin group should stop warfarin if they took before,then changed to Low molecular weight heparin calcium injection 100 U/kg,subcutaneous injection,taking RFCA when INR was lower than 1.5,stopping low molecular weight heparin 12 h before surgery;Low molecular weight heparin calcium injection 100 U/kg was intravenously injected when surgery;orally tak-ing Warfarin sodium tablet 4.5 mg after 4-6 h,once a day,meanwhile bridged overlapping treated at least 3-5 d with low molecu-lar weight heparin;monitoring once INR every 3 d after surgery,maintaining INR 2.0-3.0,taking warfalin at least 3 months. Pa-tients in dabigatran group stopped taking the anticoagulant drugs when admission,then changed to Dabigatran etexilate capsule 110 mg（age≥70 years old or body mass〈60 kg）or 150 mg（age〈70 years old or body mass≥60 mg）,twice a day;stopping dabig-atran 24 h before surgery,the same medication as warfalin group when surgery;orally taking dabigatran after 6 h,taking at least 3 months. The total mortality rate,incidence of stroke（transient cerebral ischemia,ischemic encephalopathy）,peripheral thrombosis rate and incidence of bleeding after 1 and 3 month（s）in 2 groups were observed. RESULTS：There were no significant differences in the total mortality rate,incidence of stroke,peripheral thrombosis rate and incidence of bleeding after 1 and 3 month（s） in 2 groups（P〉0.05）. CONCLUSIONS：Dabigatran has similar anticoagulant efficacy and safety with warfarin in atrial fibrillation pa-tients after RFCA.