非瓣膜性心房颤动左心耳封堵术后利伐沙班抗凝的临床疗效

Clinical effect of rivaroxaban in patients with non-valvular atrial fibrillation after percutaneous left atrial appendage closure

目的:探讨非瓣膜性心房颤动左心耳封堵术(LAAC)后,使用新型口服抗凝药物利伐沙班与华法林对比,预防左心耳封堵器相关血栓的临床疗效。方法:将非瓣膜性心房颤动AAL后207例患者,随机分为利伐沙班组(n=104)和华法林组(n=103),术后抗凝45 d后双联抗血小板治疗,通过术后45 d、6个月食道心脏超声监测,观察左心耳封堵器器械相关血栓发生率,随访观察患者出血事件及脑卒中发生率。结果:利伐沙班组与华法林组相比,器械相关血栓发生率,差异无统计学意义。脑卒中利伐沙班组为2例,华法林组为2例,系统性栓塞华法林组1例,利伐沙班组为零,差异均无统计学意义;大出血、颅内出血事件利伐沙班组较华法林组显著降低(P<0.05)。结论:利伐沙班用于非瓣膜性心房颤动LAAC术后抗凝安全有效。

Objective:This study sought to compare the clinical efficacy of rivaroxaban with warfarin in the prevention of device-related thrombus after left atrial appendage closure(LAAC)in patients with nonval-vular atrial fibrillation(AF).Methods:207 patients with nonvalvular AF after LAAC were randomized to receive rivaroxaban(n-104)or warfarin(n-103).After 45 days of anticoagulation,dual antiplatelet treatment was used.The incidence of device-related thrombus was observed by transesophageal echocardiography at 45 days and 6 months after LAAC.Stroke and bleeding events were asked during follow-up.Results:Compared with warfarin,there were no significant differences in the incidence of device-related thrombus in rivaroxaban group.There were also no signifificant differences between groups for the embolic events:stroke(2 with rivaroxaban vs.2 with warfarin)and systemic embolism(0 with rivaroxaban vs.1 with warfarin).The incidence of massive hemorrhage and intracranial hemorrhage in rivaroxaban group was significantly lower than that in warfarin(P<0.05).Conclusions:Rivaroxaban is safe and effective in anticoagulation after LAAC for nonvalvular AF.