利伐沙班与华法林用于心房颤动导管消融术后抗凝疗效对比

Comparison in anticoagulation efficacy between rivaroxaban and warfarin after radiofrequency catheter ablation of atrial fibrillation

目的 比较利伐沙班与华法林在心房颤动（房颤）患者导管消融术后的抗凝效果。方法 选取2013年3月~2015年4月榆林市星元医院老年病科和普外科的房颤行射频消融术患者100例，其中男性57例，女性43例，年龄36~78岁。随机分为利伐沙班组和华法林组，各50例。华法林组患者术后2.5 mg/日华法林，利伐沙班组术后利伐沙班10 mg/日进行治疗。三个月后观察疗效。治疗前后检测两组患者的国际标准化比率（INR）。统计治疗期间两组患者血栓栓塞发生情况和出血情况。结果 利伐沙班组治疗后INR高于华法林组[（2.6±0.4） vs. （1.9±0.5）]，差异有统计学意义（P＜0.05）。利伐沙班组有41例患者达标，达标率为82.0%，华法林组有25例患者达标，达标率为50.0%，利伐沙班组达标率高于华法林组，差异有统计学意义（P＜0.05）。利伐沙班组患者发生外周血栓栓塞1例（2.0%），轻微出血1例（2.0%）。华法林组患者发生血栓栓塞2例（4.0%），分别为外周血栓和脑血栓，轻微出血5例，少量出血4例，严重出血1例。利伐沙班组出血率显著低于华法林组（2% vs. 20.0%），差异有统计学意义（P＜0.05）。结论 利伐沙班较华法林可显著提高行导管射频消融术的房颤患者抗凝效果，降低患者出血发生率，疗效安全可靠。

Objective To compare the anticoagulation efficacy between rivaroxaban and warfarin in patientswith atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). Methods AF patients undergone RFCA(n=100, male 57, female 43 and aged from 36 to 78) were chosen from Mar. 2013 to Apr. 2015, and randomlydivided into rivaroxaban group and warfarin group (each n=50). The warfarin group was given warfarin (2.5 mg)every day after RFCA and rivaroxaban group was given rivaroxaban (10 mg) every day after RFCA. The curativeeffect was observed after 3 m. The international normalized ratio (INR) was detected before and after treatment.The incidence of thrombembolia and bleeding events were observed in 2 groups during treatment. Results INRwas higher in rivaroxaban group than that in warfarin group [(2.6±0.4) vs. (1.9±0.5), P<0.05]. There were 41patients controlled and the control rate was 82.0% in rivaroxaban group, and 25 controlled and the control rate was50.0% in warfarin group (P<0.05). There was 1 patient (2.0%) with peripheral blood thrombembolia and 1 (2.0%)with mild bleeding in rivaroxaban group. There were 2 patients (4.0%) with thrombembolia (peripheral thrombosisand cerebral thrombosis), 5 with mild bleeding, 4 with less bleeding and 1 with severe bleeding in warfarin group.The bleeding rate was significantly lower in rivaroxaban group than that in warfarin group (2% vs. 20.0%, P<0.05).Conclusion Compared with warfarin, rivaroxaban can significantly improve anticoagulation efficacy and reducebleeding rate with safe and reliable curative effect in AF patients undergone RFCA.