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的影响  

Effect of non-vitamin K antagonist oral anticoagulants on activated coagulation time during radiofrequency ablation of atrial fibrillation

作　　者：鲍伟 汤诗韵 胡晓芹 李菲 葛力萁 韦慧 陈文苏 张权 张柏祥 赵新亮 黄硕 徐子恒 张超群 王志荣 李承宗 Bao Wei;Tang Shiyun;Hu Xiaoqin;Li Fei;Ge Liqi;Wei Hui;Chen Wensu;Zhang Quan;Zhang Baixiang;Zhao Xinliang;Huang Shuo;Xu Ziheng;Zhang Chaoqun;Wang Zhirong;Li Chengzong(Department of Cardiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属医院心内科,徐州221000

出　　处：《中华心律失常学杂志》2024年第5期406-411,共6页Chinese Journal of Cardiac Arrhythmias

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(房颤)射频消融术中活化凝血时间(ACT)的影响,为制订更优的肝素负荷方案,提高ACT达标率提供一定依据。方法本研究为回顾性队列研究。选取2019年10月至2021年11月在徐州医科大学附属医院心内科行房颤射频消融术的患者,术前抗凝方案为达比加群酯110 mg,2次/d、利伐沙班15 mg,1次/d。按术前不同抗凝方案分为利伐沙班组和达比加群酯组,在肝素给药前及初始肝素给药后30 min及其后每30 min测定ACT,比较两组间差异;通过将基础ACT分段的方法,比较两组患者ACT达标情况。结果共入选364例患者,年龄(60.6±10.4)岁,其中男255例。利伐沙班组289例,达比加群酯组75例。2组患者在年龄、性别、术前服用非抗凝药等基线资料差异均无统计学意义。在合并冠心病、术前在活化部分凝血活酶时间(APTT)、基础ACT、术中ACT首次达标耗时、首剂单位体重肝素用量等比较差异有统计学意义(P<0.05)。分段基础ACT条件下,Q5(200 s≤基础ACT<250 s)组中的2组患者首剂肝素给药剂量中差异有统计学意义[(46.8±10.6)U/kg对(60.4±20.8)U/kg,P<0.05],达比加群酯组患者更低,而基础ACT[(217.7±12.2)U/kg对(214.9±13.9)U/kg,P=0.451]、首剂达标率(45.4%对51.8%,P=0.656)差异无统计学意义(P>0.05),由此可以看出在分段ACT的基础上,达比加群酯组在Q5组中可以通过较少的肝素剂量达到与利伐沙班相似的达标率。结论对于术前应用不同NOAC抗凝方案的房颤患者,ACT达标率差异无统计学意义,但通过分段基础ACT指导给药,可以使术中ACT更快更合理达标。Objective To investigate the effect of non-vitamin K antagonist oral anticoagulants(NOAC)on activated coagulation time(ACT)during radiofrequency ablation of atrial fibrillation(AF),and to provide a basis for developing a better heparin loading regimen,and to improving the ACT compliance rate.Methods This was a retrospective cohort study.Patients with AF who underwent radiofrequency ablation in the Department of Cardiology,Aiffiliated Hospital of Xuzhou Medical University from October 2019 to November 2021 were included according to the inclusion and exclusion criteria.Preoperative anticoagulation regimens were dabigatran(110 mg tablets,2 times daily)and rivaroxaban(15 mg tablets,1 time/day).Patients were divided into rivaroxaban group and dabigatran group according to different preoperative anticoagulation regimens.The ACT values were measured before and every 30 minutes after heparin administration,and the differences between the two groups were compared.By segmenting the baseline ACT,the ACT compliance between the two groups we compared.Results A total of 364 cases were selected[255 males,mean age[(60.6±10.4)years].including 289 in the rivaroxaban group and 75 in the dabigatran group.There was no difference in baseline data including age,sex,or preoperative non-anticoagulant use in the two groups.There were statistical differences in patients with coronary heart disease,preoperative activated partial thromboplastin time(APTT),basic ACT,time consuming for first ACT compliance,and first dose of heparin per unit body weight(P<0.05).Under the segmented ACT condition,there was a statistically significant difference in the first dose of heparin between the two groups in the Q5(200 s≤basic ACT<250 s)which was lower in the dabigatran group,while there was no statistical difference in the compliance rate of baseline ACT and first dose(P>0.05).It can be seen that on the basis of the segmented ACT,dabigatran group in the Q5 group could achieve a similar rate to that of rivaroxabin with a lower dose heparin.ConclusionFo

关 键 词：心房颤动 射频消融 活化凝血时间 达比加群酯 利伐沙班 

分 类 号：R541.75[医药卫生—心血管疾病]