心房颤动消融术后应用达比加群酯和华法林抗凝疗效观察

目的研究达比加群酯在心房颤动(简称房颤)射频消融术后抗凝治疗的有效性及安全性。方法选择已行导管射频消融术治疗的房颤患者,按应用口服抗凝药物的不同分为华法林组和达比加群酯组。收集所有患者的年龄、性别、房颤类型、凝血及肝肾功能等基本指标。所有患者符合入选及排除标准,均于射频消融术后应用达比加群酯或华法林行抗凝治疗。对患者进行3个月随访,以血栓性终点与安全性终点为研究终点,对比两组患者的临床疗效和出血风险。结果华法林组133例,达比加群酯组98例。两组间性别、年龄、房颤类型、伴随疾病及吸烟史等无差异。与华法林组比较,达比加群酯组血栓栓塞事件发生率无差异(4.08%vs 4.51%,P0.05)。严重出血事件更低(1.02%vs 6.77%,P0.05)。达比加群酯组及华法林组均有少量出血事件发生,两组发生率无差异(31.63%vs 33.08,P0.05)。结论达比加群酯对房颤射频消融术后抗凝治疗的效果与华法林相当,但安全性更高。     

达比加群酯对非瓣膜性房颤导管消融围术期抗凝疗效和安全性的 Meta 分析

目的：系统评价达比加群酯对非瓣膜性房颤导管消融围术期的抗凝疗效和安全性。方法计算机检索 PubMed、EMbase、The Cochrane Library（2016年第2期）、CMB、知网、万方和维普数据库,搜集有关房颤导管消融围术期使用达比加群酯和华法林抗凝治疗的随机对照及非随机对照的研究文献,由两位评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用 RevMan 5．3软件进行 Meta 分析。结果最终纳入23个研究、共7673例患者。Meta 分析结果显示：达比加群酯组脑卒中或短暂性脑缺血发生率与华法林组无明显区别[OR ＝1．0,95％CI：0．60～1．68,P ＝0．99],大出血事件发生率无明显区别[OR ＝0．79,95％CI：0．52～1．19, P ＝0．25],小出血事件发生率显著降低[OR ＝0．71,95％CI：0．57～0．87,P ＝0．001]。结论达比加群酯在房颤导管消融围术期抗凝疗效及大出血并发症的发生率上与华法林无明显区别,小出血并发症的发生率较华法林降低。     

540例持续性心房颤动患者华法林抗凝治疗安全性的临床观察

为评价华法林用于持续性心房颤动 (简称房颤 )患者抗凝治疗的安全性 ,对 5 4 0例持续性房颤患者进行华法林抗凝治疗 ,观察治疗过程中的出血及其它不良反应。结果 :华法林用量为 2 .5 4± 0 .7(1～ 6 )mg/d ,治疗维持国际标准化率 (INR)在 2～ 3范围时 ,轻度出血率为 3.15 % ,经相关处理并调低INR值 ,所有出血均停止 ;无一例因严重出血而终止抗凝治疗 ;未见其它不良反应。 75岁以上房颤者出血发生率增加。结论 :持续性房颤患者应用华法林抗凝治疗时 ,INR维持在 2～ 3范围可能是安全的 ;轻度出血患者经调低INR值 ,出血可以停止 ,不影响继续抗凝治疗。     

达比加群酯用于心房颤动射频消融围手术期的有效性和安全性

达比加群酯已被批准用于预防非瓣膜性房颤(atrial fibrillation,AF)的卒中及体循环栓塞。然而在AF导管消融围手术期使用达比加群酯的有效性和安全性并未得到充分的研究,本文旨在评估达比加群酯用于AF射频消融围手术期的有效性和安全性。     

华法林、达比加群酯和低分子肝素对心房颤动射频导管消融术中活化凝血时间达标情况及潜在血栓形成风险的影响

目的：评价目前心房颤动（房颤）射频导管消融术中抗凝方案的有效性和不同抗凝药对术中凝血状态的影响。方法：筛选2015年12月至2017年3月于我院行房颤射频导管消融术的患者163例,其中158例术前接受有效抗凝治疗的患者均纳入研究。根据患者服用不同药物分为三组：华法林组86例、达比加群酯组51例和低分子肝素（LMWH）组21例。分析患者房间隔穿刺后首剂肝素后活化凝血时间（ACT）达标率（First-ACT达标率）、穿间隔后1 h ACT达标率（1 h-ACT达标率）;比较三组间基础ACT值、First-ACT达标率、1 h-ACT达标率、ACT首次达标耗时、术中肝素总量情况。结果：158例患者中基础ACT结果：华法林组最接近有效范围,且三组间比较差异有统计学意义（P<0.001）;与达比加群酯组及LMWH组比较,华法林组的First-ACT达标率及1 h-ACT达标率明显升高,而ACT首次达标耗时和术中肝素总量明显减低,差异均有统计学意义（P均<0.05）;达比加群酯组及LMWH组比较差异无统计学意义（P>0.05）。结论：目前临床上参考体重和ACT监测给予肝素的术中抗...     

利伐沙班和达比加群酯及华法林在非瓣膜性心房颤动患者抗凝治疗的研究

目的比较新型抗凝药物利伐沙班和达比加群酯与传统抗凝药物华法林在非瓣膜性心房颤动(房颤)患者缺血性脑卒中预防的有效性和安全性。方法选择我院门诊及病房治疗的非瓣膜性房颤患者160例,患者均未服抗凝药,根据患者服药意愿分别纳入利伐沙班组80例(拜瑞妥,20mg,1次/d)和达比加群酯组80例(泰毕全,110mg,2次/d),选择本院同期服用华法林的房颤患者80例为华法林组,所有患者服药≥3个月,3组在年龄、性别、房颤血栓危险度评分及房颤射频消融术方面相匹配。随访3个月,比较3组患者缺血性脑卒中、非中枢神经系统性栓塞事件、出血事件及不良反应的发生率。结果利伐沙班组和达比加群酯组栓塞事件发生率均低于华法林组(11.3%和13.8%vs 28.8%,P=0.008),利伐他班组和达比加群酯组出血事件发生率亦较华法林组低(10.0%和7.5%vs 21.3%,P=0.022)。华法林组皮疹发生率较利伐沙班组和达比加群组高(11.3%vs 0%和2.5%,P=0.002)。结论新型口服抗凝药物利伐沙班和达比加群酯对非瓣膜性房颤患者缺血性脑卒中预防效果优于或等同于华法林,安全性亦较好,值得临床推广应用。     

达比加群酯在非瓣膜性房颤抗凝治疗中的应用

目的比较达比加群酯和华法林在非瓣膜性心房颤动患者的抗凝治疗过程中疗效和安全性。方法对2013年3月—2014年2月收治的54例住院及门诊随诊房颤患者的临床资料进行回顾性分析。结果华法林组31例中发生脑栓塞2例,死亡1例,死亡原因为心力衰竭,轻微出血5例。达比加群酯组23例中发生脑栓塞1例,轻微出血1例。结论达比加群酯在非瓣膜性房颤抗凝治疗中可有效进行抗凝治疗,并有效提高患者依从性。     

达比加群酯对比华法林二联抗凝方案在高龄心房颤动合并冠心病患者抗栓治疗中的效果评估

[目的]探讨达比加群酯对比华法林二联抗凝方案在高龄心房颤动(AF)合并冠心病(CHD)患者抗栓治疗中的临床效果。[方法]选取本院于2018年8月—2019年12月收治的198例高龄AF合并CHD患者为研究对象,采用随机数字表法分为观察组和对照组各99例。观察组采用达比加群酯治疗,对照组采用华法林二联抗凝方案,即华法林联合抗血小板药物(阿司匹林)治疗。随访1年。比较两组抗栓治疗疗效。比较两组治疗前、治疗后1、6、12个月的凝血酶原时间(PT)、国际标准化比值(INR)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、D-二聚体(D-D)、血小板计数(PLT)、C反应蛋白(CRP)以及血清尿酸变化情况。观察并记录两组治疗期间的血栓事件、出血事件以及用药不良反应发生情况。[结果]治疗1、6、12个月后,观察组和对照组PLT、CRP、D-D水平均呈逐渐明显下降趋势(F=42.417、18.254、44.582,均P<0.001);两组PT、INR、TT、APTT、Fib相比治疗前均显著改善(F=356.521、5.689、112.526、35.417、5.62...     

达比加群酯在阵发性心房颤动射频消融术后抗凝治疗的临床应用

目的探讨达比加群酯在阵发性心房颤动(简称房颤)射频消融术后抗凝治疗的安全性。方法将60例阵发性房颤射频消融术后患者,随机分为达比加群酯组(30例)和华法林组(30例),观察两组患者射频消融术后抗凝治疗的安全性。结果达比加群酯组及华法林组均无血栓栓塞及大出血并发症发生,而少量出血并发症的发生率与华法林相似,两组在血栓栓塞及出血并发症方面差异均无统计学意义(P0.05)。与华法林组比较,达比加群酯组的D-二聚体水平减低[(0.25±0.16)mg/L vs(0.45±0.25)mg/L,P0.05],术后住院时间减少[(3.05±0.32)d vs(7.27±0.25)d,P0.05]。结论阵发性房颤射频消融术后应用达比加群酯是安全的。     

华法林在心房颤动抗凝治疗中的应用

心房颤动(AF)是最常见的持续性心律失常,其主要可能致命的危险就是血栓形成。华法林抗凝治疗可显著减少2/3卒中风险,对瓣膜病和非瓣膜病AF均有效,但存在监测较麻烦、治疗窗窄、有潜在出血危险等不利之处。本文比较了华法林临床应用与其他口服凝血酶抑制剂和Xa因子拮抗剂及抗血小板药物治疗的现状。     

Continuous warfarin versus periprocedural dabigatran to reduce stroke and systemic embolism in patients undergoing catheter ablation for atrial fibrillation or left atrial flutter

Purpose

Left atrial catheter ablation for patients with atrial fibrillation (AF) requires periprocedural anticoagulation to minimize thromboembolic complications. High rates of major bleeding complications using dabigatran etexilate for periprocedural anticoagulation have been reported, raising concerns regarding its safety during left atrial catheter ablation. We sought to evaluate the safety and efficacy of a dabigatran use strategy versus warfarin, at a single high-volume AF ablation center.

Methods

We performed a retrospective analysis on consecutive patients undergoing left atrial ablation at Vanderbilt Medical Center from January 2011 through August 2012 with a minimum follow-up of 3 months. Patient cohorts were divided into two groups, those utilizing dabigatran etexilate pre- and post-ablation and those undergoing ablation on dose-adjusted warfarin, with or without low-molecular-weight heparin bridging. Dabigatran was held 24–30 h pre-procedure and restarted 4–6 h after hemostasis was achieved. We evaluated all thromboembolic and bleeding complications at 3 months post-ablation.

Results

A total of 254 patients underwent left atrial catheter ablation for atrial fibrillation or left atrial flutter. Periprocedural anticoagulation utilized dabigatran in 122 patients and warfarin in 135 patients. Three late thromboembolic complications occurred in the dabigatran group (2.5 %), compared with one (0.7 %) in the warfarin group (p?=?0.28). The dabigatran group had similar minor bleeding (2.5 vs. 7.4 %, p?=?0.07), major bleeding (1.6 vs. 0.7 %, p?=?0.51), and composite of bleeding and thromboembolic complications (6.6 vs. 8.9 %, p?=?0.49) when compared to warfarin. There were no acute thromboembolic complications in either group (<24 h post-ablation).

Conclusions

In patients undergoing left atrial catheter ablation for AF or left atrial flutter, use of periprocedural dabigatran etexilate provides a safe and effective anticoagulation strategy compared to warfarin. A prospective randomized study is warranted.     

Demographic profile of patients undergoing catheter ablation of atrial fibrillation

Demographic Profile of Patients Undergoing AF Ablation. Background: Catheter ablation is a widely accepted treatment for drug refractory atrial fibrillation (AF). The purpose of our study was to examine secular trends in the demographic profile of patients undergoing AF ablation. Methods and Results: Data for 792 patients who underwent catheter ablation for AF at Johns Hopkins Hospital between years 2001 and 2009 were systematically reviewed. There has been a steady increase in total number of procedures and repeat procedures. The majority of patients undergoing AF ablation at our institution are men (76.6%). Females accounted for 36.0% of patients in 2001 versus 19.6% in 2009. A total of 93.3% of patients undergoing AF ablation were Caucasian. The mean age of patients has increased over time (52 years in 2001 to 60 years in 2009, P = 0.015) and the number of antiarrhythmic drugs (AADs) used prior to first ablation has decreased (2.3 to 1.2, P = 0.009). In addition, the mean duration of AF prior to first referral has decreased (7.8 years in 2001 vs 4.2 years in 2009). Conclusion: There is a significant gender and racial disparity in patients undergoing AF ablation favoring Caucasian men that warrants further investigation. We also observed a significant increase in age of patients, decrease in number of AADs, and increase in number of repeat procedures. These results are important when interpreting outcomes of AF ablation and designing future trials. (J Cardiovasc Electrophysiol, Vol. 22, pp. 994‐998, September 2011)     

Symptomatic and asymptomatic atrial fibrillation in patients undergoing radiofrequency catheter ablation

INTRODUCTION: The goals of this study were to (i) evaluate the feasibility and results of monitoring patients prior to and following catheter ablation of AF with the mobile cardiac outpatient telemetry (MCOT) system and to (ii) correlate symptoms and the presence or absence of atrial fibrillation (AF). METHODS AND RESULTS: A total of 19 consecutive patients (12 men [63%]; age 60 +/- 6 years) with highly symptomatic drug refractory AF underwent catheter ablation. Each was provided with a MCOT monitor (CardioNet, USA) and asked to wear it 5 days immediately before the ablation, and 5 days per month starting with the ablation for 6 consecutive months. When patients experienced any symptoms, they were asked to activate the system and to record associated symptoms. A total of 494 days (11,856 hours) were monitored. Out of the total 390 events triggered by patient's symptoms, 40% were confirmed as AF events (156) and 60% were confirmed as non-AF events (234). Only shortness of breath and chest discomfort were highly associated with AF (P < 0.05). At the end of 6 months of follow-up, out of 10 patients that completed the study, 7 (70%) patients were free of symptomatic AF recurrences whereas only 5 (50%) patients achieved success when asymptomatic AF recurrences were included in the outcome. CONCLUSIONS: The results of this study demonstrate the potential utility of wireless monitoring systems in the follow-up of AF ablation patients, while also identifying poor patient compliance with an intensive monitoring protocol as an important limitation.