经皮植入左心耳封堵器后不同抗凝药物应用的安全性及有效性观察

Safety and efficacy of different anticoagulants after left atrial appendage closure with Watchman device

目的观察经皮植入左心耳封堵器(Watchman封堵器,美国波士顿科学公司)后不同抗凝药物应用的安全性及有效性。方法本研究为回顾性研究,入选2014年10月至2018年3月在宁波市第一医院心律失常诊疗中心接受经皮植入Watchman封堵器的非瓣膜性心房颤动(房颤)患者,术后45 d内服用抗凝药物,根据抗凝药物类型将患者分为华法林组、达比加群酯组和利伐沙班组。比较术中参数及围术期并发症(血栓栓塞事件、出血事件及死亡事件),术后45 d复查经食管超声心动图,比较残余分流及封堵器表面血栓情况。结果共入选212例成功植入Watchman封堵器患者,其中华法林组60例、达比加群酯组94例、利伐沙班组58例。3组患者均未发生围术期血栓栓塞事件以及死亡事件。华法林组、达比加群酯组、利伐沙班组在围术期出血事件(大出血事件:3.3%对0对0;轻微出血事件:5.0%对2.1%对1.7%;P>0.05)、术后残余分流(<3 mm:18.5%对18.2%对18.5%;3~5 mm:1.9%对1.1%对1.9%;P>0.05)、封堵器表面血栓形成比例(3.7%对1.1%对1.9%,P>0.05)差异无统计学意义。结论经皮植入Watchman封堵器后45 d内,服用达比加群酯和利伐沙班在安全性和有效性上与华法林相当。

Objective To investigate the safety and efficacy of using different anticoagulants after left atrial appendage closure with Watchman device.Methods Patients with successfully Watchman device implanted were included.All the patients received anticoagulants within 45 days after the procedure.The study patients were divided into 3 groups according to the type of anticoagulants.The procedural data and complications were compared among 3 groups.Transesophageal echocardiography follow-up was performed 45 days post-procedure for residual flow and device-related thrombus.Results A total of 212 patients were consecutively selected.The patients were divided into 3 groups:warfarin group(n=60),dabigatran group(n=94),and rivaroxaban group(n=58).The peri-procedure complications(major bleeding:3.3%vs.0 vs.0;minor bleeding:5.0%vs.2.1%vs.1.7%;P>0.05),residual flow(<3 mm:18.5%vs.18.2%vs.18.5%;3-5 mm:1.9%vs.1.1%vs.1.9%;P>0.05)and device-related thrombus(3.7%vs.1.1%vs.1.9%,P>0.05)were comparable among the groups.Conclusion The safety and efficacy of dabigatran and rivaroxaban was comparable with warfarin within 45 days after Watchman device implantation.