心房颤动导管消融术应用达比加群酯-华法林桥接治疗抗凝的安全性和有效性

Dabigatran bridging for warfarin anticoagulation post catheter ablation of atrial fibrillation

目的 本文旨在评估心房颤动（房颤）患者导管消融术后应用达比加群酯-华法林桥接治疗的安全性和有效性以及住院时间及经济费用的差别.方法 2014年10月至2015年9月在青岛大学附属医院心内科连续330例接受导管消融的房颤患者,按术后的抗凝方法分为3组：华法林和低分子肝素桥接治疗组（H-W组,n=114）;达比加群酯组（D组,n=105）;华法林和达比加群酯桥接组（D-W组,n=111）.INR（国际标准化比值）达到2～3时停用达比加群酯,单用华法林.术后随访1个月,比较3组患者的血栓栓塞事件、大出血、小出血、住院天数、抗凝费用.结果 术后1个月随访中患者无死亡病例,未发生缺血性脑卒中及短暂性脑缺血发作（TIA）,无全身性栓塞及肺栓塞,无大出血事件发生.3组患者小出血的发生率相似（H-W组30例,D组21例,D-W组18例;P=0.55）.H-W 组的住院时间明显长于D组及D-W组[（8.68±1.45）d对（4.40±0.98）d对（4.56±1.07）d,P〈0.01].D-W组消融术后1个月所用的抗凝费用要低于D组及H-W组[（289.8±15.78）元对（1200±0.00）元对（963.6±25.5）元,P〈0.01）].结论房颤患者导管消融术后应用达比加群酯-华法林桥接抗凝与低分子肝素-华法林桥接抗凝或单用达比加群酯一样安全性、有效,与低分子肝素和华法林桥接治疗比较,可以减少住院时间,且比低分子肝素-华法林桥接抗凝或单用达比加群酯花费要少.

Objective Anticoagulation with dabigatran,albeit costlier than warfarin,is effective peri-ablation of atrial fibrillation（AF）.The present study was to evaluate the safety,efficacy and hospitalization duration of combination use of dabigatran as bridging therapy for warfarin anticoagulation post ablation.Methods Three hundred and thirty consecutive patients with AF underwent ablation were divided into three anticoagulation strategies：warfarin with low molecular weight heparin（LMWH）bridging（n=114,H-W group）;dabigatran（n=105,D group）;and warfarin with dabigatran bridging（n=111,D-W group）.Bridging was discontinued when INR reached 2～3.One-month rates of thromboembolic events,death,major and minor bleeding,hospitalization duration and anticoagulation cost were compared.Results There was no ischemic stroke,transient ischemic attack,systemic or pulmonary embolism,death,or major bleeding in any group;and there was a similar minor bleeding rate among three groups（30,21 and 18 cases in H-W,D,D-W groups;P=0.55）at l-month post ablation.Hospitalization duration was longer in H-W group than that in D and D-W groups[（8.68±1.45）d vs.（4.40±0.98）d vs.（4.56±1.07）d,P〈0.01].The anticoagulation cost one month post ablation was significantly lower in D-W group than D group and in H-W group[（289.8±15.78）CNY vs.（1 200±0.00）CNY vs.（963.6±25.5）CNY,P〈0.01].Conclusion Post ablation of AF,dabigatran bridging appeared as safe and efficacious as LMWH bridging for warfarin anticoagulation or dabigatran alone,with shorter hospitalization than LMWH bridging,and reduced cost than LMWH bridging for warfarin anticoagulation or dabigatran alone.