心房颤动患者导管消融围术期应用口服抗凝药安全性观察

Safety of oral anticoagulants in perioperative period of ablation for atrial fibrillation

目的 探讨心房颤动（房颤）患者在导管消融围术期应用华法林及非维生素K拮抗剂口服抗凝药（NOACs）的安全性.方法 连续入选263例在南京大学医学院附属鼓楼医院接受射频导管消融或冷冻球囊消融的非瓣膜病性房颤患者并根据入院前服用抗凝药种类分为3组,3组患者参照指南分别接受华法林组（目标国际标准化比值2.0～3.0）、达比加群酯组（110 mg,每日2次）及利伐沙班组（20 mg,每日1次）治疗,术前不间断抗凝至少3周,消融术后至少持续3～6个月,首要观察终点为围术期主要出血事件,次要观察终点为其他出血事件及栓塞事件.结果 3组患者的基线资料差异无统计学意义.华法林组和利伐沙班组各有1例患者术后发现假性动脉瘤,达比加群酯组1例患者出现心脏压塞,其他出血事件方面华法林组与达比加群酯组及利伐沙班组差异无统计学意义 [18.3％（13/71）对12.0％（13/108）对19.0％（16/84）,P=0.345].3组患者均未出现围术期栓塞事件.结论 房颤消融围术期应用达比加群酯或利伐沙班相较华法林安全性相同.

Objective To evaluate the safety of warfarin and new non-vitamin K antagonist oral anticoagtlants anticoagulants（NOACs） in patients undergoing ablation of atrial fibrillation.Methods Two hundred and sixty three patients with non-valvular atrial fibrillation（NVAF）who underwent catheter ablation or cryoballoon ablation were selected.We divided patients into three groups to receive either warfarin（target international normalized ratio 2.0-3.0）or dabigatran（110 mg twice daily）or rivaroxaban（20 mg once a day）,ablation was performed after at least 3weeks of uninterrupted anticoagulation,which was continued for 12 to 24 weeks after ablation.The primary endpoint was the incidence of major bleeding events;secondry endpoint included other bleeding and thromboembolic events.Results Baseline characteristics were balanced between treatment groups.One case of vascular pseudoaneurysm occurred in each warfarin and rivaroxaban group,one case of pericardial tamponade occurred in dabigatran group.The three treatment groups had a similar incidence of other bleeding events[18.3％（13/71）vs.12.0％（13/108）vs.19.0％（16/84）,P=0.345].No thromboembolic events occurred in all of the patients.Conclusion Compared to warfarin,the use of dabigatran or rivaroxaban in patients underwent ablation for NVAF was safety.