非维生素K拮抗剂口服抗凝药治疗非瓣膜性心房颤动相关左心耳血栓的单中心研究  

Non-vitamin K oral anticoagulants for left atrial appendage thrombus resolution in nonvalvular atrial fibrillation:a single-center study

作　　者：刘俊鹏[1] 李若宁 张亚同[3] 张瑞生[1] 王珺 王华[1] 杨杰孚[1] Liu Junpeng;Li Ruoning;Zhang Yatong;Zhang Ruisheng;Wang Jun;Wang Hua;Yang Jiefu(Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pharmacy,The Fifth Affiliated Hospital of Xin Jiang Medical University,Urumqi 830011,China;Department of Pharmacy,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院心内科国家老年医学中心,中国医学科学院老年医学研究院,100730 [2]新疆医科大学第五附属医院药学部,830011 [3]北京医院药学部,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中华心律失常学杂志》2021年第6期537-541,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：北京市科委基金面上项目(D181100000218003)。

摘　　要：目的了解并发左心耳血栓(LAAT)的非瓣膜性心房颤动(NVAF)患者接受非维生素K拮抗剂口服抗凝药(NOAC),包括低剂量NOAC治疗的效果及安全性。方法回顾性观察了2011年11月至2021年1月北京医院因NVAF相关LAAT接受口服抗凝药治疗的28例患者,其中男20例,年龄(68.5±2.0)岁,均完成经食管超声心动图复查并证实血栓消退,收集患者合并症、血肌酐、影像学检查等临床信息及药物应用、血栓消退时间等治疗经过并进行分析。结果起始接受NOAC治疗患者16例,起始接受华法林治疗12例,其中3例在治疗期间更换口服抗凝药。NOAC、低剂量NOAC(达比加群酯110 mg,每日2次或利伐沙班15 mg,每日1次)和华法林的血栓消退率在6个月时分别为66.7%(12/18)、70%(7/10)和64.3%(9/14)(P=0.96),在12个月时分别为88.9%(16/18)、80%(8/10)和78.6%(11/14)(P=0.69),平均血栓消退时间分别为3、3.5个月和4个月(P=0.97)。安全性方面,发生严重出血1例,脑卒中2例,均为华法林治疗患者,1例达比加群酯治疗患者出现消化道症状并导致换药。结论NOAC治疗NVAF相关LAAT的疗效与华法林相当,消退血栓速度及安全性有潜在优势。低剂量NOAC同样有效,治疗NVAF相关LAAT可行。Objective To evaluate the effectiveness and safety of non-valvular atrial fibrillation(NVAF)patients with left atrial appendage thrombosis(LAAT)receiving non-vitamin K oral anticoagulants(NOAC),including low-dose NOAC.Methods We retrospectively observed 28 patients(20 males,age 68.5±2.0 years old)who received oral anticoagulant therapy for NVAF-related LAAT in Beijing Hospital from November 2011 to January 2021.All the cases were reviewed by transesophageal echocardiography(TEE)before and after NOAC treatment.The relevant clinical information and treatment data were collected and analyzed.Results Sixteen patients were initially treated with NOAC,and 12 patients were initially treated with warfarin,of which 3 patients changed oral anticoagulants during the treatment.The thrombus regression rates of NOAC,low-dose NOAC(dabigatran 110 mg Bid/rivaroxaban 15 mg Qd),and warfarin were 66.7%(12/18),70%(7/10)and 64.3%(9/14)at 6 months(P=0.96),88.9%(16/18),80%(8/10),and 78.6%(11/14)at 12 months(P=0.69),and the average time of thrombus resolution was 3 months,3.5 months,and 4 months,respectively(P=0.97).In terms of safety,there were 1 case of severe bleeding and 2 cases of strokes,all of which were treated with warfarin.One patient receiving dabigatran developed gastrointestinal symptoms.Conclusion NOAC are as efficacious as warfarin in the treatment of LAAT in patients with NVAF,which may have potential advantages in resolving thrombus faster and having better safety.Low-dose NOACs are equally effective and safe,could be a potential option for the treatment of LAAT.

关 键 词：心房颤动 左心耳血栓 抗凝 

分 类 号：R541.75[医药卫生—心血管疾病]