Division of Cardiology, Department of Medicine, Georgia Regents University, Augusta, Georgia, USA.
J Cardiovasc Electrophysiol. 2013 Aug;24(8):861-5. doi: 10.1111/jce.12143. Epub 2013 Apr 11.
Uninterrupted oral anticoagulant (OA) therapy with warfarin has become the standard of care at many centers performing catheter ablation of atrial fibrillation (AF). Compared with warfarin, dabigatran, a direct thrombin inhibitor, has been demonstrated to reduce the risk of stroke in nonvalvular AF with similar bleeding risk. Few data exist on the safety profile of uninterrupted dabigatran therapy during AF ablation.
We compared the safety and efficacy of uninterrupted OA therapy with either warfarin or dabigatran in all patients undergoing AF catheter ablation at the University of Alabama at Birmingham between November 1, 2010 and January 31, 2012. All patients underwent a transesophageal echocardiogram (TEE) on the day of their ablation procedure to assess for the presence of intracardiac thrombi. All complications were identified and classified as bleeding, thromboembolic events, or other.
There were 212 patients in the dabigatran group and 251 patients in the warfarin group. The groups were well matched. There were 3 complications in the dabigatran group and 6 in the warfarin group (P = 0.45). There were 2 bleeding complications in the dabigatran group and 6 in the warfarin group (P = 0.23). There was one thromboembolic complication (a possible TIA) in the dabigatran group and none in the warfarin group (P = 0.28).
The administration of dabigatran is as safe and effective as warfarin for uninterrupted OA therapy during catheter ablation of AF.
在许多进行房颤导管消融的中心，华法林的不间断口服抗凝（OA）治疗已成为护理标准。与华法林相比，直接凝血酶抑制剂达比加群在非瓣膜性房颤中降低卒中风险的效果与华法林相当，但出血风险相似。关于房颤消融期间不间断达比加群治疗的安全性概况，数据较少。
我们比较了 2010 年 11 月 1 日至 2012 年 1 月 31 日期间在阿拉巴马大学伯明翰分校进行房颤导管消融的所有患者中不间断 OA 治疗使用华法林或达比加群的安全性和疗效。所有患者在消融手术当天均行经食管超声心动图（TEE）检查，以评估是否存在心内血栓。所有并发症均经识别并分类为出血、血栓栓塞事件或其他。
达比加群组有 212 例患者，华法林组有 251 例患者。两组患者相匹配。达比加群组有 3 例并发症，华法林组有 6 例（P = 0.45）。达比加群组有 2 例出血并发症，华法林组有 6 例（P = 0.23）。达比加群组有 1 例血栓栓塞并发症（可能为 TIA），华法林组无此类并发症（P = 0.28）。
达比加群用于房颤导管消融期间不间断 OA 治疗与华法林一样安全有效。
