摘要
目的探讨经皮左心耳封堵术后口服新型口服抗凝药物(NOACs)对器械表面血栓形成和出血事件的影响。方法纳入2014年5月至2016年8月在武汉亚洲心脏病医院心内科接受经皮左心耳封堵术并完成术后45 d门诊随访的患者189例。根据术后不同抗凝方案进行分组:术后口服NOACs进行抗凝治疗者为NOACs组(29例),术后口服华法林进行抗凝治疗者为华法林组(160例)。收集并比较两组患者的临床基线资料、术中资料及术后短期随访资料。结果两组患者年龄、性别、高血压病、卒中史、冠心病史、先天性心脏病、心肌病、心力衰竭、CHA2DS2-VASc评分等基线资料比较,差异均无统计学意义(均P> 0.05);而NOACs组糖尿病比例(34.5%比15.6%,P=0.016)、HAS-BLED评分[(2.3±1.0)分比(1.7±1.2)分,P=0.008]显著高于华法林组,差异均有统计学意义。两组患者封堵器压缩比、成功封堵率、残余分流发生率、残余分流大小、器械表面血栓形成发生率、卒中发生率等术中资料比较,差异均无统计学意义(均P> 0.05)。在术后45 d随访时,两组患者残余分流大小、器械表面血栓形成发生率、缺血性卒中发生率、总出血发生率、脑出血发生率、小出血发生率比较,差异均无统计学意义(均P> 0.05);但NOACs组患者残余分流发生率显著小于华法林组(21.7%比45.4%,P=0.034),差异有统计学意义。结论NOACs用于经皮左心耳封堵术后抗凝治疗,其短期随访不增加器械表面血栓形成及出血事件发生率。
Objective This retrospective cohort study aimed to investigate the safety and effi cacy of novel oral anticoagularts(NOACs)after percutaneous left atrial appendage closure(LAAC).Methods Patients who had underwent percutaneous LAAC at Wuhan Asia Heart Hospital between May 2014 to August 2016 were consecutively included in the study.A total of 189 consecutive patients underwent percutaneous LAAC were eventually entrolled.29 patients received NOACs and 160 patients received warfarin as post-operative anticoagulation therapy for at least 45 days.Patients receiving NOACs were compared with patients receiving warfarin as the control.Baseline clinical data,procedural parameters and postoperative outcomes and assessment at 45-day follow up were collected and compared between the 2 groups.Results Patients receiving NOACs had higher HAS-BLED scores[(2.3±1.0)vs.(1.7±1.2),P=0.008],and lower rate of residual fl ow at 45-day follow up(21.7%vs.45.4%,P=0.034).Device-related thrombosis(DRT),ischemic stroke and bleeding rates at 45-day follow up showed no signifi cant diff erences between the two groups.Conclusions According to our single center experience,the effi cacy and safety of NOACs were comparable to those of warfarin as postoperative anticoagulation after percutaneous LAAC.
作者
陈雨意
陈艳红
张勇华
黄尾平
黄克强
许蓓
苏晞
CHEN Yu-yi;CHEN Yan-hong;ZHANG Yong-hua;HUANG Wei-ping;HUANG Ke-qiang;XU Bei;SU Xi(Department of Cardiology,Wuhan Asia Heart Hospital,Wuhan 430022,China)
出处
《中国介入心脏病学杂志》
2018年第10期547-552,共6页
Chinese Journal of Interventional Cardiology
基金
湖北省卫生和计划生育委员会联合基金(WJ2018H0043)
武汉中青年医学骨干人才培养计划
关键词
经皮左心耳封堵术
新型口服抗凝药物
华法林
器械表面血栓形成
Percutaneous left atrial appendage closure
Novel oral anticoagulants
Warfarin
Device-related thrombosis
