心房颤动射频消融围术期短暂中断和不中断非维生素K拮抗剂口服抗凝药的有效性和安全性比较  

Comparison of efficacy and safety of minimally interrupted and uninterrupted non-vitamin K antagonist oral anticoagulants during atrial fibrillation ablation

作　　者：白剑[1] 沈文志 刘宇 陈诤 顾蓉[1] 马冬辉[1] 徐伟[1] Bai Jian;Shen Wenzhi;Liu Yu;Chen Zheng;Gu Rong;Ma Donghui;Xu Wei(Department of Cardiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院心内科,210008

出　　处：《中华心律失常学杂志》2020年第4期357-361,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(81870291)。

摘　　要：目的本研究旨在观察射频消融术前短暂中断和不中断非维生素K拮抗剂口服抗凝药(NOACs)两种抗凝治疗方案的有效性和安全性,为NOACs的围术期临床应用提供参考。方法本研究为回顾性研究。连续纳入2019年1月至2020年1月在南京大学医学院附属鼓楼医院心内科行射频消融治疗的非瓣膜病心房颤动(房颤)患者,所有入选患者均接受NOACs(利伐沙班或达比加群酯)抗凝治疗>3周。将手术当天停服1次NOACs的患者纳入短暂中断组,将术前不中断NOACs的患者纳入未中断组。观察两组患者术中活化凝血时间(ACT)、肝素使用总量以及围术期和术后30 d的全因死亡、血栓栓塞、出血等并发症的发生情况。结果两组患者的基线资料各项指标差异无统计学意义(P>0.05)。短暂中断组患者的基线ACT值明显低于未中断组[(130.8±17.8)s对(158.9±19.5)s,P<0.001],而术中肝素使用总量明显高于未中断组[(11987.3±2890.1)U对(9376.9±2295.5)U,P<0.001];两组患者围术期及术后30 d全因死亡、血栓栓塞及出血等并发症的发生差异无统计学意义(P>0.05)。结论房颤射频消融围术期短暂中断和不中断NOACs两种抗凝方案显示出相似的有效性和安全性,均可以作为房颤射频消融围术期的抗凝策略。Objective The aim of this study is to observe the effectiveness and safety of minimally interrupted and uninterrupted non-vitamin K antagonist oral anticoagulants(NOACs)during atrial fibrillation ablation,and provide a reference for the perioperative clinical application of NOACs.Methods This study was a retrospective study.Patients with non-valvular atrial fibrillation who underwent radiofrequency ablation in Nanjing Drum Tower Hospital from January 2019 to January 2020 were consecutively enrolled.All enrolled patients received anticoagulation treatment with NOACs(rivaroxaban or dabigatran)for more than 3 weeks.Patients who interrupted 1 dose of NOACs before radiofrequency ablation were included in the minimally interrupted group,and patients who uninterrupted NOACs during radiofrequency ablation were included in the uninterrupted group.The baseline ACT value and total heparin dose during radiofrequency ablation,and the all-cause death,thromboembolic and bleeding events during the perioperative period and within 30 days after radiofrequency ablation were observed.Results There were no significant differences in baseline data between the two groups(P>0.05).The baseline ACT value of the minimally interrupted group was significantly lower than the uninterrupted group[(130.8±17.8)s vs.(158.9±19.5)s,P<0.001].The total heparin dose in the minimally interrupted group was significantly higher than that in the uninterrupted group[(11987.3±2890.1)U vs.(9376.9±2295.5)U,P<0.001].There were no significant differences in all-cause death,thromboembolic and bleeding events during the perioperative period and within 30 days after radiofrequency ablation between the two groups(P>0.05).Conclusion Both minimally interrupted and uninterrupted NOACs during atrial fibrillation ablation show the similar effectiveness and safety,and can be used as a perioperative anticoagulation strategy for atrial fibrillation ablation.

关 键 词：心房颤动 射频消融 非维生素K拮抗剂口服抗凝药 

分 类 号：R541.75[医药卫生—心血管疾病]