王鹏宇 郝应禄 李燕萍 杨明 梁梅 赵静思

【摘要】 目的：探讨非瓣膜病性房颤患者导管消融围术期应用利伐沙班不间断与间断抗凝方案的有效性及安全性。方法：选取2018年12月-2019年12月90例在本院行导管消融术的房颤患者，按照随机数字生成器法分为不间断组、间断组、华法林组，每组30例。观察术前3周至术后2个月内出血事件及具有临床症状的栓塞事件。结果：三组患者围术期均未发生具有临床症状的栓塞事件。三组围术期均无栓塞及卒中事件，无中度及严重出血。三组轻度出血发生率比较，差异无统计学意义（P>0.05）。结论：房颤消融围术期利伐沙班不间断与间断抗凝方案均有良好的有效性及安全性，不劣于華法林间断抗凝，不间断方案有望被更多的医生及患者接受。

【关键词】 利伐沙班 心房颤动 抗凝 导管消融

The Effective and Safe Observation of Rivaroxaban Uninterrupted and Intermittent Anticoagulation during Perioperative Period of Patients with Atrial Fibrillation/WANG Pengyu， HAO Yinglu， LI Yanping， YANG Ming， LIANG Mei， ZHAO Jingsi. //Medical Innovation of China， 2021， 18（32）： -143

[Abstract] Objective： To investigate the efficacy and safety of Rivaroxaban uninterrupted and intermittent anticoagulant regimens during perioperative catheter ablation in patients with non-valvular atrial fibrillation. Method： A total of 90 patients undergoing catheter ablation of atrial fibrillation in our hospital from December 2018 to December 2019 were selected， and they were divided into uninterrupted group， intermittent group and Warfarin group according to the random number generator method， 30 patients in each group. Bleeding events and embolization events with clinical symptoms were observed from 3 weeks before surgery to 2 months after surgery. Result： No embolism event with clinical symptoms occurred in the three groups during perioperative period. In this study， there were no events of embolism， stroke， and moderate or severe bleeding among the three groups during perioperative period. There was no significant difference in the incidence of mild bleeding events among three groups （P>0.05）. Conclusion： Both Rivaroxaban uninterrupted and intermittent anticoagulation regimens during perioperative atrial fibrillation ablation have good efficacy and safety， and are not inferior to Warfarin intermittent anticoagulation， the uninterrupted regimen is expected to be accepted by more doctors and patients.

[Key words] Rivaroxaban Atrial fibrillation Anticoagulant Catheter ablation

First-author’s address： The Sixth Affiliated Hospital of Kunming Medical University， Yuxi 653100， China

doi：10.3969/j.issn.1674-4985.2021.32.035

心房颤动（atrial fibrillation，AF）是临床常见的心律失常之一，我国2010年调查显示房颤患病率为0.65%，较2004年调查结果呈增高趋势[1-2]。房颤患者有着比非房颤患者更高的缺血性脑卒中、体循环动脉栓塞、心肌梗死发生风险，能加重心衰症状，降低生活质量[3]。近年来，房颤导管消融术（catheter ablation，CA）在转复并维持窦性心律、减少心血管事件和改善生活质量等方面有较好的疗效，CA成功率高，安全有效[4]。最新指南Ⅰa类推荐CA用于药物无法控制的阵发性房颤，但是需要优化围术期抗凝方案，在栓塞及出血风险之间寻找平衡[5]。CA围术期抗凝方案分为不间断及间断两种，其选择仍存在争议[6-7]。本研究以此为背景，探讨非瓣膜病性房颤患者导管消融围术期伐沙班不间断与间断抗凝的有效性及安全性，以期对房颤CA患者围术期抗凝提供参考。……