达比加群与华法令在心房颤动导管消融中抗凝治疗的对比研究

Comparison of dabigatran and warfarin anticoagulant therapy during catheter ablation in patients with atrial fibrillation

目的:比较达比加群和华法令在心房颤动导管消融抗凝治疗中的疗效和安全性。方法:回顾性分析2011年1月至2014年8月325例于我院行房颤射频消融术患者的临床资料。根据围术期抗凝治疗方案,患者被分为达比加群组(187例)和华法令组(138例)。比较两组一般资料、血浆凝血酶原时间国际标准化比值(INR)、活化凝血时间(ACT)、肺静脉隔离(PVI)成功率、手术时间和并发症发生率。结果:与华法令组比较,达比加群组糖尿病(20.3%比11.8%)、慢性心力衰竭比例(19.6%比10.2%)和左房内径[(47±10)mm比(44±9)mm]均显著降低,P<0.05或<0.01。达比加群组INR显著低于华法令组[(1.3±0.3)比(2.4±0.4),P=0.001],而两组ACT、PVI成功率和手术时间无显著差异(P均>0.05)。达比加群组主要并发症发生率显著低于华法令组(0.5%比5.1%,P=0.025)。结论:在心房颤动导管消融抗凝治疗中,与华法令相比,达比加群治疗的INR显著降低,且主要并发症率显著降低,值得临床推广。

Objective： To compare therapeutic effect and safety of dabigatran and warfarin anticoagulant therapy during catheter ablation in patients with atrial fibrillation （AF）. Methods： Clinical data of 325 AF patients, who received catheter ablation in our hospital from Jan 2011 to Aug 2014, were retrospectively analyzed. According to perioperative anticoagulant therapy plan, patients were divided into dabigatran group （n = 187） and warfarin group （n= 138）. General data, international normalized ratio （INR）, activated coagulation time （ACT）, success rate of pulmonary vein isolation （PVI）, operation time and incidence rate of complications were compared between two groups. Results： Compared with warfarin group, there were significant reductions in percentages of diabetes mellitus （20. 3% vs. 11.8%）, chronic heart failure （19.6% vs. 10.2%） and left atrial diameter [ （47± 10） mm vs. （44± 9） mm] in dabigatran group, P〈0.05 or 〈0.01. INR of dabigatran group was significantly lower than that of warfarin group [ （1.3 ± 0.3） vs. （2.4 ± 0.4）, P = 0. 0011, and there were no significant difference in ACT, success rate of PVI and operation time between two groups （P〉0.05 all）. Incidence rate of main complications in dabigatran group was significantly lower than that of warfarin group （0.5% vs. 5.1%, P = 0. 025）. Conclusion： Compared with warfarin, there is significant reduction in INR and incidence rate of main comolications during catheter ahlation in dabigatran group , which is worth extending.