新型口服抗凝药对非瓣膜性心房颤动患者左心耳血栓的疗效分析  

Analysis of the effect of New oral anticoagulants on left atrial fibrillation

作　　者：王琼瑶 李文 张磊[2] 戈晓珍 赵华[4] 张涛[4] 韩智红[4] 任学军[4] WANG Qiongyao;LI Wen;ZHANG Lei;GE Xiaozhen;ZHAO Hua;ZHANG Tao;HAN Zhihong;REN Xuejun(Department of Cardiology,The First People’s Hospital of Loudi,Loudi 417000,China)

机构地区：[1]湖南省娄底市第一人民医院心内科,417000 [2]西北大学附属医院西安市第三医院心内三科 [3]河北北方学院附属第一医院心内科 [4]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科3A病房

出　　处：《心肺血管病杂志》2021年第5期416-419,425,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:观察新型口服抗凝药(NOACs)对非瓣膜性心房颤动患者左心耳血栓(LAAT)的影响及效果评估。方法:回顾性分析2018年6月至2020年1月,在北京安贞医院心内科因心房颤动行导管消融治疗的患者960例,术前均行经食道超声心动图(TEE)检查。存在LAAT的患者33例(3.4%),口服NOACs治疗后23例复诊。观察服用NOAC≥3周左心耳血栓的消退情况,左心耳血栓消失或减小定义为有效,无变化或增大定义为无效。结果:33例左心耳血栓患者中CHA2DS2-VASc评分≤1分为17例(51.5%,其中0分4例,1分13例)。23例患者中,服用利伐沙班15 mg/d 6例,有效5例(83.3%),服药时长112(54,352)d;达比加群酯110 mg 2次/d 7例,有效2例(28.6%),服药时长69(28,265)d;达比加群酯150 mg 2次/d10例,有效9例(90%),服药时长78(44,190)d。达比加群酯110 mg 2次/d治疗无效的5例,改用达比加群酯150 mg2次/d,服药≥3周后再次复查TEE,4例(80%)血栓消失。达比加群酯110 mg 2次/d与150 mg 2次/d对比,有效率差异有统计学意义(P<0.05)。结论:NOACs对非瓣膜性心房颤动患者左心耳血栓的治疗有效,高剂量的NOACs效果优于低剂量。低的栓塞风险评分心房颤动患者也有较高的左心耳血栓检出率。Objective:To observe the effect of New oral anticoagulants(NOACs)on Left atrial appendage thrombosis(LAAT)in patients with non-valvular atrial fibrillation.Methods:A retrospective analysis was performed on 960 patients undergoing catheter ablation for atrial fibrillation in the Department of Cardiology,Beijing Anzhen Hospital from June 2018 to January 2020.All patients underwent transesophageal echocardiography(TEE)before ablation.A total number of 33 patients(3.4%)were checked with LAAT,23 of them were revisited after treating with oral NOACs.To observe the regression of LAAT after taking NOACs for≥3 weeks,the disappearance or decrease of left atrial appendage thrombus was defined as effective,while no change or increase was defined as ineffective.Results:The number whose CHA_(2)DS_(2)-VASc score≤1 was 17 cases(51.5%,including 4 cases with 0 score and 13 cases with 1 score)among the 33 patients.Among the 23 patients,5 out of 6(83.3%)patients initially took rivaroxaban 15 mg qd were effective,the duration of medication was 112(54,352)d.2 out of 7(28.6%)taking Dabigatran 110 mg bid were effective,duration of medication was 69(28,265)d.10 cases took Dabigatran 150 mg bid,and 9 cases(90%)were effective among them,and the duration of medication was 78 d(44,190).Among the 5 patients who failed to respond to 110 mg bid with Dabigatran,TEE was rechecked after changed to 150 mg bid with regular medication≥3 weeks,among which 4 patients(80%)had thrombus disappeared.Compared with dabigatran 110 mg bid and 150 mg bid,the effective rate was significantly different(P<0.05).Conclusions:NOACs are effective in the treatment of left atrial appendage thrombosis in patients with nonvalvular atrial fibrillation,and high dose NOACs is better than low dose.Patients with a lower embolism risk score for atrial fibrillation also had a higher detection rate of left atrial appendage thrombosis.

关 键 词：心房颤动 新型口服抗凝药 左心耳血栓 

分 类 号：R54[医药卫生—心血管疾病]