心房颤动导管消融患者围术期短期启动新型口服抗凝药的有效性和安全性

Efficacy and safety of short-term initiation of new oral anticoagulants in perioperative period of ablation for atrial fibrillation

目的探讨心房颤动患者在导管消融围术期短期启动新型口服抗凝药物治疗的有效性和安全性。方法回顾分析2016年12月至2017年6月在中国医学科学院阜外医院单中心行射频或冷冻导管消融治疗的非瓣膜性心房颤动患者97例(阵发性心房颤动72例和持续性心房颤动25例),根据抗凝情况分为两组:常规组34例,术前不间断口服达比加群抗凝3周以上;短期组65例,术前3 d启动达比加群抗凝。研究观察的主要终点事件为血管穿刺后至术后48 h发生的血栓和栓塞事件,次要终点事件包括大出血和(或)小出血事件。结果短期组和常规组的年龄[(59.0±9.1)岁比(58.8±10.4)岁,P=0.915]、CHA2DS2-VASc评分(2.5±2.0比2.5±1.8,P=0.956)、HAS-BLED评分(1.2±0.9比1.2±0.8,P=0.821)等基线指标差异均无统计学意义。两组术中活化凝血时间差异无统计学意义[(245.6±50.8)s比(234.4±50.9)s,P=0.308]。所有患者住院期间未记录到血栓和栓塞事件,并且无大出血事件。在小出血事件方面,短期组有3例腹股沟穿刺部位瘀斑或血肿,常规组有5例,但两组小出血事件发生率差异无统计学意义(4.6%比15.6%,P=0.110)。结论心房颤动患者于导管消融术前短期启动新型口服抗凝药物的方案有效且安全。

Objective To explore the efficacy and safety of short-term initiation of a new type of oral anticoagulants in perioperative period of ablation for atrial fibrillation. Methods The 97 patients with non-valvular atrial fibrillation(72 patients with paroxysmal atrial fibrillation and 25 patients with persistent atrial fibrillation)who underwent catheter ablation at the single center of Fuwai Hospital of the Chinese Academy of Medical Sciences were retrospectively analyzed.According to the anticoagulant situation,they were divided into two groups:34 patients in the converntional group who received more than 3 weeks uninterrupted dabigatran;and 65 patients in short-term group who received 3 days before ablation.The primary endpoint was the thrombotic and embolic events occurred from vascular puncture to 48 h postoperative.Secondary endpoints included major bleeding and/or minor bleeding events. Results There was no statistical significance on baseline characteristics between the short-term and conventional groups including age[(59.0±9.1)years old vs.(58.8±10.4)years old,P=0.915],CHA2DS2-VASc score(2.5±2.0 vs.2.5±1.8,P=0.956)and HAS-BLED score(1.2±0.9 vs.1.2±0.8,P=0.821).No thrombotic,embolic events,or major bleeding occurred in all patients.There were 3 minor bleeding events which is inguinal ecchymosis or hematoma in the short-term group and 5 in the routine group,but there was no significant difference(4.6%vs.15.6%,P=0.110). Conclusions It is effective and safe to initiate short-term new oral anticoagulant therapy in perioperative period of ablation for atrial fibrillation.