Department of Cardiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan,
Clin Drug Investig. 2013 Nov;33(11):847-53. doi: 10.1007/s40261-013-0134-5.
Two new oral anticoagulants, rivaroxaban and dabigatran, with no need for anticoagulation monitoring, are available for patients with atrial fibrillation (AF). We aimed to compare their anticoagulant effects and safety when used during the AF ablation periprocedural period.
Patients undergoing AF ablation were randomly assigned to receive rivaroxaban 15 mg once daily (N = 30) or dabigatran 110 mg twice daily (N = 30). Rivaroxaban was withheld on the morning of the day before the ablation, and dabigatran was discontinued from the evening of the day before the procedure. Both anticoagulants were then resumed after haemostasis of the access site. D-dimer levels were measured just before the ablation, at the end of the ablation, and at 24 h and 48 h after the procedure.
The baseline D-dimer levels were identical in both groups. However, D-dimer levels increased more markedly following the ablation procedure in patients receiving rivaroxaban than in those receiving dabigatran (mean ± standard deviation from 0.62 ± 0.16 to 1.09 ± 0.38 μg/mL vs from 0.59 ± 0.08 to 0.75 ± 0.17 μg/mL; p < 0.0001). The rate of rebleeding from the access site was similar in patients receiving rivaroxaban and those receiving dabigatran (33 vs 27%; p = 0.78).
As compared with dabigatran, rivaroxaban may increase the risk of hypercoagulability when used during the periprocedural period of AF ablation, suggesting a potential rebound effect of rivaroxaban or a mismatch between its half-life and dose regimen.
两种新型口服抗凝剂，利伐沙班和达比加群，无需抗凝监测，可用于房颤（AF）患者。我们旨在比较它们在 AF 消融围手术期使用时的抗凝效果和安全性。
接受 AF 消融的患者被随机分配接受利伐沙班 15 mg 每日一次（N = 30）或达比加群 110 mg 每日两次（N = 30）。利伐沙班在消融前一天的早晨停用，达比加群在手术前一天的晚上停用。两种抗凝剂在进入部位止血后恢复使用。在消融前、消融结束时以及消融后 24 小时和 48 小时测量 D-二聚体水平。
两组患者的基线 D-二聚体水平相同。然而，接受利伐沙班治疗的患者在消融后 D-二聚体水平升高更为明显，而接受达比加群治疗的患者则不然（从 0.62 ± 0.16 至 1.09 ± 0.38 μg/mL，平均值 ± 标准差；从 0.59 ± 0.08 至 0.75 ± 0.17 μg/mL；p < 0.0001）。接受利伐沙班治疗的患者和接受达比加群治疗的患者的进入部位再出血率相似（33% 比 27%；p = 0.78）。
与达比加群相比，利伐沙班在 AF 消融围手术期使用时可能会增加血液高凝风险，提示利伐沙班可能存在反弹作用或其半衰期与剂量方案不匹配。
