心房颤动伴慢性肾脏病患者经皮左心耳封堵术后抗栓治疗方案研究

Antithrombotic therapeutic regimens for atrial fibrillation patients with chronic kidney disease after receiving left atrial appendage closure: a clinical study

目的探讨非瓣膜性心房颤动(房颤)伴慢性肾脏病(CKD)患者经皮左心耳封堵术(LAAC)后最佳抗栓治疗方案。方法对2018年1月至2019年2月于上海周浦医院接受LAAC治疗的68例非瓣膜性房颤伴CKD患者进行单中心回顾性分析。其中,38例LAAC术后服用华法林至少45 d(A组),30例术后服用双联抗血小板治疗6个月(B组)。观察两组患者围术期以及术后3、6、12个月随访期装置相关血栓(DRT)、血栓栓塞事件和大出血事件发生率。结果两组患者年龄、性别、永久性房颤、伴高血压、伴糖尿病、伴冠心病、伴心力衰竭、脑卒中史、CHA2DS2-VASc评分、HAS-BLED评分等基线资料差异均无统计学意义(P>0.05)。两组患者LAAC术均获成功。两组患者围手术期7 d内心脏压塞、血栓栓塞及大出血事件发生率差异均无统计学意义(P>0.05);术后45~60 d DRT、血栓栓塞、大出血事件及死亡发生率差异均无统计学意义(P>0.05);术后1年血栓栓塞、大出血事件及死亡发生率差异均无统计学意义(P>0.05)。结论房颤伴CKD患者经皮LAAC术后双联抗血小板治疗,不增加近期DRT、血栓栓塞及大出血事件风险。

Objective To determine the optimal antithrombotic therapeutic regimen for non-valvular atrial fibrillation patients with chronic kidney disease(CKD) after receiving left atrial appendage closure(LAAC). Methods The single-center clinical data of 68 non-valvular atrial fibrillation patients with CKD,who received LAAC therapy during the period from January 2018 to February 2019 at Shanghai Zhoupu Hospital of China, were retrospectively analyzed. Among the 68 patients, 38 patients took warfarin for at least 45 days after LAAC(group A), and other 30 patients received dual antiplatelet therapy for 6 months after LAAC(group B). The incidences of device-related thrombosis(DRT), thrombo-embolism events and massive bleeding events in perioperative period as well as within 3, 6 and 12 months after LAAC were compared between the two groups. Results Between the two groups, there were no statistically significant differences in the baseline data, including age, sex, the coexisting hypertension, diabetes, coronary heart disease, heart failure, the history of stroke, CHA2DS2-VASc score, and HAS-BLED score(P>0.05). Successful LAAC was accomplished in all patients of both groups. No statistically significant differences in the incidence of pericardial tamponade, thrombo-embolism events and massive bleeding events within 7 days after LAAC existed between the two groups(P>0.05). The differences in the incidence of DRT, thrombo-embolism events and massive bleeding events in 45-60 days after LAAC were not statistically significant between the two groups(P >0.05). One year after LAAC, the differences in the incidence of thrombo-embolism events, massive bleeding events and death were not statistically significant between the two groups(P>0.05). Conclusion For non-valvular atrial fibrillation patients with CKD after receiving LAAC, dual antiplatelet therapy will not increase the short-term occurrence risks of DRT, thrombo-embolism events and massive bleeding events.