非维生素K拮抗剂口服抗凝药对心房颤动射频消融术中活化凝血时间达标的影响  

Effect of non-vitamin K antagonist oral anticoagulants on activated clotting time compliance during catheter ablation of atrial fibrillation

作　　者：汤诗韵 李承宗 李菲 胡晓芹 葛力萁 韦慧 陈文苏 张超群 王志荣 TANG Shi-yun;LI Cheng-zong;LI Fei;HU Xiao-qin;GE Li-qi;WEI Hui;CHEN Wen-su;ZHANG Chao-qun;WANG Zhi-rong(Department of Cardiology,Affiliated Hospital of Xuzhou Medical College,Xuzhou221000,Jiangsu,China)

机构地区：[1]徐州医科大学附属医院心内科,江苏徐州221000

出　　处：《中国心脏起搏与心电生理杂志》2023年第1期21-25,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：徐州市科技重点研发计划(KC19158);徐州医科大学附属医院发展基金项目(XYFM2021007)。

摘　　要：目的研究非维生素K拮抗剂口服抗凝药(NOAC)对心房颤动(简称房颤)射频消融术中活化凝血时间(ACT)的影响,为制定更优的肝素负荷方案,提高ACT达标率提供一定依据。方法按入选排除标准纳入自2019年10月至2021年11月在徐州医科大学附属医院心内科行射频消融术的房颤患者。术前抗凝方案为达比加群酯(110 mg,2次/天)、利伐沙班(15 mg,1次/天)。患者均给予100U/Kg首剂肝素,在肝素给药前及初始肝素给药后30min(30min-ACT)及其后每30min测定ACT值。按30min-ACT分为:达标组(ACT≥250 s),未达标组(ACT<250 s)。按基础ACT分为基础ACT≤145 s;145 s<ACT<160 s;160 s≤ACT≤170 s,170 s<ACT<200 s。结果共入选122例,其中达标组47例,未达标组75例。达标组与未达标组年龄、性别、合并疾病、术前服用非抗凝药等基线资料均无差异。两组患者在活化部分凝血活酶时间,基础ACT方面有统计学差异(P<0.05);进一步行多因素回归分析,两组患者仅在基础ACT方面存在统计学差异(P<0.05)。122例患者中30min-ACT达标47例(38.5%)。基础ACT是影响30min-ACT达标的关键因素,基础ACT越低越不容易达标,两者呈线性相关(y=152.007+0.429x,P<0.05)。术前服用达比加群酯抗凝的患者基础ACT要高于服用利伐沙班抗凝的患者[(167±18)svs(156±19)s,P<0.05]。两组患者术后24 h无血栓发生,术后腹股沟血肿3例(达比加群1例,利伐沙班2例)。基础ACT分段分析未达标率:ACT≤145 s组73%,145 s<ACT<160 s组71%,160 s≤ACT≤170 s组59%,170 s<ACT<200 s组41%,基础ACT越低越不容易达标,四组未达标率有差异(P<0.05)。结论对于术前应用NOAC抗凝方案的房颤患者,应尝试在分段基础ACT的前提下,增加术中首剂肝素剂量,以达到指南推荐的术中抗凝强度。Objective To study the effect of non-vita min K antagonist oral anticoagulant(NOAC)on activated clotting time(ACT)during catheter ablation of atrial fibrillation(AF),and to provide basis for developing a more optimal heparin loading regimen to improve the ACT attainment rate.Method Patients with AF who received catheter ablation at the Department of Cardiology,Xuzhou Medical University Hospital from October 2019 to December 2021 were included according to the inclusion and exclusion criteria.The preoperative anticoagulation regimen was dabigatran(110 mg bid)and rivaroxaban(15 mg qd).Patients were given a first dose of heparin at 100 U/Kg,and ACT values were measured before and 30 min after initial heparin ad ministration and every 30 min thereafter.The group was divided according to 30 min-ACT:ACT targeting rate group(ACT≥250 s),and ACT non-targeting rate group(ACT<250s).The group was divided into basal ACT≤145s;145 s<ACT<160 s;160s≤ACT<170 s,170 s<ACT<200 s according to basal ACT.Results A total of 122 patients were enrolled,of which 47 were in the targeting rate group and 75 in the non-targeting rate group.There were no differences in age,gender,comorbidities,or using nonanticoagulant before operation between the targeting rate group and ACT non-targeting rate group.There was a statistical difference between the two group in terms of APPT and bascal ACT(P<0.05).Further multifactorial regression analysis was performed and only the base ACT was statistically different(P<0.05).47(38.5%)of the 122 patients achieved the targeting rate.The basic ACT was a key factor in achieving 30 min-ACT,and the lower the basic ACT,the less likely it was to be achieved,with a linear correlation(y=152.007+0.429x,P<0.05).The basic ACT was higher in patients who taking dabigatranate than rivaroxaban[(167±18)s vs(156±19)s,P<0.05].No thrombosis occurred in both groups at 24 h postoperatively and there were three cases of postoperative inguinal haematoma(one case of dabigatran and two cases of rivaroxaban).The basal ACT segmental

关 键 词：心血管病学 心房颤动 导管射频消融 活化凝血时间 肝素 抗凝药 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学] R973.2[医药卫生—临床医学]