心房颤动患者射频消融围术期抗凝药物使用情况单中心调查

Investigation on the use of the peri-procedural anticoagulants in patients undergoing ablation of atrial fibrillation

目的调查分析本院心血管内科心房颤动(简称房颤)患者射频消融围术期抗凝药物使用情况。方法顺序收集2017年12月1日至2018年09月30日于本院行房颤射频消融患者的临床资料信息,调查其抗凝药物使用种类、剂量。按口服抗凝药种类(华法林、达比加群、利伐沙班)分组,比较各组患者的基本临床资料,分析不同卒中风险、出血风险及不同肾功能情况下各种抗凝药使用比例。结果177例患者中,160例(90.4%)使用新型口服抗凝药(NOAC)抗凝(达比加群77例,利伐沙班83例),17例(9.6%)使用华法林抗凝。华法林、达比加群、利伐沙班三组患者中,达比加群组阵发性房颤比例显著高于利伐沙班组(70.1%vs 41.0%,P<0.05)。阵发性房颤患者三组抗凝药使用比例分别是11.1%(11/99)、54.5%(54/99)、34.3%(34/99),持续性房颤患者三组抗凝药使用比例分别为7.7%(6/78)、29.5%(23/78)、62.8%(49/78)。所有入选患者中,122例(69.0%)为卒中高危(CHA2DS2-VASc≥2分)患者,16例(9.0%)为出血高危(HAS-BLED≥3分)患者。各类抗凝药在不同出血风险和不同肾功能情况下的使用比例均无差异(P>0.05)。结论射频消融围术期的房颤患者均接受了抗凝治疗,其中卒中高危患者比例较高,抗凝治疗采用NOAC的比例较高。

Objective To investigate the use of the peri-procedural anticoagulants in patients with atrial fibrillation(AF)undergoing radiofrequency catheter ablation(RFCA)in our hospital during the NOAC era.Methods We sequentially collected the clinical data and information of anticoagulant therapy of 177 patients with AF underwent RFCA from December 1,2017 to September 30,2018.All patients were divided into three groups according to the types of oral anticoagulants:warfarin group,dabigatran group,rivaroxaban group.The baseline clinical data of three groups were compared,and the proportions of various anticoagulants under different risks of stroke,bleeding and renal functions were analyzed.Results Of the 177 patients,160(90.4%)patients received NOAC(77 patients with dabigatran,83 patients with rivaroxaban),17(9.6%)patients received warfarin.Among three groups,the proportion of paroxysmal AF was significantly higher in the dabigatran group than in the rivaroxaban group(70.1%vs 41.0%,P<0.05).In patients with paroxysmal AF,the proportion of anticoagulants used in three groups was 11.1%,54.5%and 34.3%,respectively,while the proportion was 7.7%,29.5%and 62.8%,respectively,in patients with persistent AF.A-mong all patients,122(69.0%)patients were at high risk of stroke(9.0%)patients were at high risk of bleeding(HAS-BLED score≥3).There was no statistical difference in the proportion of each anticoagulant used in different bleeding risks and different renal functions(P>0.05).Conclusion All patients with AF undergoing RFCA received anticoagulant therapy.The proportion of patients with high risk of stroke is higher and the use of NOAC for anticoagulation therapy is higher.[Chinese Journal of Cardiac Pacing and Electrophysiology,2020,34(2):120-123]