利伐沙班用于心房颤动冷冻消融术中抗凝治疗的安全性和有效性观察  

Efficacy and safety of Rivaroxaban anticoagulant therapy in the treatment of atrial fibrillation cryoablation

作　　者：邸成业[1] 万征[2] 林文华[1] 

机构地区：[1]天津医科大学心血管病临床学院泰达国际心血管病医院,300457 [2]天津医科大学总医院心血管病中心

出　　处：《中华医学杂志》2017年第33期2591-2594,共4页National Medical Journal of China

摘　　要：目的观察新型口服抗凝药利伐沙班用于非瓣膜性心房颤动（房颤）患者冷冻消融术中抗凝治疗的安全性和有效性。方法人选2013年10月至2016年12月于泰达国际心血管病医院行冷冻消融的房颤患者137例，根据冷冻消融术中应用抗凝药物分为两组：利伐沙班组（65例）和普通肝素组（72例）。利伐沙班组：术前3d开始口服利伐沙班20mg，每天一次，术日不停药，术中不再追加抗凝药物，测试活化凝血时间（ACT），术后继续口服3个月。普通肝素组：术前3d开始口服利伐沙班20mg，每天一次，术前24h停药，术中给予普通肝素（100U／kg）抗凝，监测ACT，控制在250—300s之间，术后继续口服利伐沙班3个月。比较两组患者冷冻消融术中ACT以及术中及术后住院期间出血、血栓栓塞事件的发生率有无差别。结果两组患者ACT差异具有统计学意义[（110±16）s比（323±61）s，P=0．000]，两组患者出血事件利伐沙班组2例均为股静脉穿刺部位局部血肿，发生率为3．1％（2／65）；普通肝素组2例为股静脉穿刺部位局部血肿，1例为术后鼻出血，发生率为4．2％（3／72），差异无统计学意义（P=0．549）；利伐沙班组术中和术后未发生血栓栓塞事件，普通肝素抗凝组1例患者术后抗凝桥接期发生小脑血栓栓塞事件。结论利伐沙班用于心房颤动冷冻消融术中抗凝安全有效。Objective To observe the efficacy and safety of the novel oral anticoagulant Rivaroxaban for anticoagulation therapy in patients with nonvalvular atrial fibrillation （AF） during cryoablation. Methods A total of 137 AF patients from October 2013 to December 2016 underwent cryoablation were divided into two groups according to the application of anticoagulant drugs： Rivaroxaban group （65 cases） and Heparin group （72 cases）. Rivaroxaban group： oral administration of Rivaroxaban 20 mg, once a day, was started 3 days before the cryoablation, no anticoagulant was additionally added during cryoablation, the activated clotting time （ACT） was measured, and oral administration of Rivaroxaban was continued for 3 months after cryoablation. Heparin group： oral administration of Rivaroxaban 20 mg, once a day, was stopped 24 hours before the cryoablation, heparin （100 U/kg） anticoagulation was given during cryoablation, ACT was controlled between 250 and 300 seconds, and oral administration of Rivaroxaban was continued for 3 months after cryoablation. The ACT results, the incidence of bleeding and thromboembolic events between the two groups were compared. Results The ACT result between the two groups were with statistically significance [ （ 110 ± 16 ） vs （ 323 ± 61 ） seconds, P = 0. 000） ]. The bleeding events for Rivaroxaban group were two cases of local hematoma of the femoral vein puncture site, with the incidence rate of 3.1% （2/65） ; Heparin group were two cases of local hematoma of the femoral vein puncture site, and one case of epistaxis, with the incidence rate of 4. 2% （3/72）, with no statistical significance （P = 0. 549 ） between the two groups. No thromboembolic event occurred in the Rivaroxaban group, one cerebellar thromboembolic event occurred in the Heparin group during anticoagulant bridging phase after cryoablation. Conclusion Rivaroxaban is safe and effective for anticoagulation therapy in patients with atrial fibrillation eryoablation.

关 键 词：利伐沙班 心房颤动 冷冻疗法 导管消融术 抗凝药 

分 类 号：R541.75[医药卫生—心血管疾病]