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达比加群酯用于心房颤动导管消融围术期的抗凝治疗

Anticoagulation treatment using dabigatran in perioperative period of catheter ablation of nonvalvular atrial fibrillation

摘要:

目的 观察新型口服抗凝药达比加群酯应用于非瓣膜性心房颤动(房颤)患者经导管消融围术期的抗凝疗效.方法 入选2014年8月至2016年1月于沈阳军区总医院选择导管消融治疗的房颤患者116例,依据入院前服用抗栓药情况将患者分为院前已服用达比加群酯>7 d(达比加群酯稳态)组,院前未服用抗栓药组和院前服用其他抗栓药组.比较达比加群酯稳态组与院前未服用抗栓药组的凝血指标.患者入院后随机分配至2个病区,一个病区为依诺肝素桥接组(术前和术后4~6h分别应用依诺肝素桥接),另一病区为持续应用达比加群酯组.分析两组导管消融术中首次测得激活凝血时间(ACT)值的影响因素,观察住院及随访期间出血、血栓栓塞事件的发生率.结果 达比加群酯稳态组和院前未服用抗栓药组活化部分凝血活酶时间(APTT)、凝血酶原时间(PI)差异具有统计学意义(P=0.000,P=0.029).持续应用达比加群酯组术中首次测定ACT值与最后应用达比加群酯距离手术开始时间和检测ACT前每kg体重的肝素量呈负相关;住院及随访期间发生的出血及栓塞事件两组差异无统计学意义(P>0.05).结论 达比加群酯在体内达到稳态时可使APTT值增大.导管消融术前持续应用达比加群酯未增加出血及栓塞事件.术中首次测得的ACT值与最后应用抗凝药距离手术开始时间和检测ACT前每kg体重的肝素量有关.

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abstracts:

Objective The aim of this study is to evaluate the efficacy and safety of a new oral anticogulant dabigatran in patients with nonvalvular atrial fibrillation (NVAF) undergoing catheter ablation (RF).Methods In this study,116 patients undergoing catheter ablation of atrial fibrillation from August 2014 to January 2016 in Shenyang General Hospital of PLA were enrolled.The blood coagulation indexes were compared between patients who had already taken dabigatran for more than 7 days before admission and patients without taking any anticoagulant before admission.The 116 patients were divided into 2 different wards (2 groups) after admission.In one ward (n=52),dabigatran was stopped and bridged with low molecular weight heparin (LMWH bridging group) for 2 times (before procedure and 4~6 hours after ablation).In the other ward (n=64),dabigatran was used continually just before and after catheter ablation of atrial fibrillation(dabigatran continual group).The first activated clotting time (ACT) value during ablation procedure was compared in both groups.The bleeding and thromboembolic events were also evaluated and compared during perioperative period and follow-up.Results There were significant differents in actived partial thromboplastin time (APTT) and prothrombin time(PT)between patients who have taken dabigatran for more than 7 days and who didn't take any anticoagulant before admissiion to hospital(P=0.000,P=0.029).A negative relationship between the first ACT value measured during ablation procedure and the timing of taking dabigatran before ablation procedure was obtained in dabigatran continual group.There were no significant differences in the incidences of mild bleeding and hematoma between LMWH bridging group and dabigatran continual group during peri-operative period and follow-up (P>0.05).Conclusion Dabigatran can increase the value of APTT when it reaches a stable pharmacokinetics stage.And it is effective and safe in atrial ftbrillation patients who underwent catheter ablation in peri-operative period.The first ACT value measured during the ablation procedure in dabigatran continual group has a negative relationship with the time taking the last dabigatran before catheter ablation.

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作者: 周海鹏 [1] 梁明 [1] 王祖禄 [1] 杨桂棠 [1] 孙鸣宇 [1] 金志清 [1] 丁明英 [1] 韩雅玲 [1]
第一作者: 周海鹏
栏目名称: 临床研究
DOI: 10.3760/cma.j.issn.1007-6638.2016.05.007
发布时间: 2016-12-06
基金项目:
辽宁省第四批科学技术计划资助(2014305006)The Fourth Batch of Science and Technology Plan of Liaoning Province
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