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经胸和经食管超声心动图评估达比加群酯对心房颤动患者左心耳血栓的抗凝疗效

Anticoagulation efficacy of dabigatran etexilate for left atrial appendage thrombus in patients with atrial fibrillation by transthoracic and transesophageal echocardiography.

作者信息

Xing Xiao Fei, Liu Nan Nan, Han Ya Ling, Zhou Wei Wei, Liang Ming, Wang Zu Lu

机构信息

Department of Cardiology, General Hospital of Shenyang Military Command of PLA, Shenyang, Liaoning Province, China.

出版信息

Medicine (Baltimore). 2018 Jun;97(26):e11117. doi: 10.1097/MD.0000000000011117.

Abstract

To evaluate the anticoagulation efficacy of dabigatran etexilate for left atrial appendage (LAA) thrombus resolution in patients with atrial fibrillation by transthoracic echocardiography and transesophageal echocardiography, and to investigate the anticoagulation factors.A total of 58 atrial fibrillation patients with LAA thrombus in our hospital were enrolled. After dabigatran etexilate anticoagulation for 3 months, the patients were divided into the effective group and ineffective group according to dissolution of thrombosis. The baseline data and the left atrial diameter (LAD), left atrial ejection fraction (LAEF), left ventricular ejection fraction, LAA flow velocity (LAA-v), and LAA thrombus size before and after anticoagulation treatment were recorded, and the measurement index were statistically analyzed.After the patients received anticoagulation treatment for 3 months, 15 patients had complete dissolution, thrombus in 21 patients reduced significantly, and the complete dissolution rate was 25.9% (15/58), the effective rate of dissolution was 62.1% (36/58). Compared with the ineffective group, the proportion of persistent atrial fibrillation and LAD in effective group were lower than those in the ineffective group, the LAEF and LAA-v in the effective group were higher than those in the ineffective group, and the differences were statistically significant (P < .05). Multivariate logistic regression analysis on the baseline data and each ultrasound index showed that the type of atrial fibrillation, LAD, LAEF, and LAA-v were independently associated with the efficacy of anticoagulation (P < .05).Dabigatran etexilate is effective in dissolution of LAA thrombus in patients with atrial fibrillation, and the atrial fibrillation type, LAD, LAEF, and LAA-v are significantly related with the efficacy of anticoagulation.

摘要

通过经胸超声心动图和经食管超声心动图评估达比加群酯对心房颤动患者左心耳(LAA)血栓溶解的抗凝疗效,并探讨抗凝相关因素。纳入我院58例伴有LAA血栓的心房颤动患者。给予达比加群酯抗凝治疗3个月后,根据血栓溶解情况将患者分为有效组和无效组。记录基线数据以及抗凝治疗前后的左心房直径(LAD)、左心房射血分数(LAEF)、左心室射血分数、LAA血流速度(LAA-v)和LAA血栓大小,并对测量指标进行统计学分析。患者接受抗凝治疗3个月后,15例患者血栓完全溶解,21例患者血栓明显缩小,完全溶解率为25.9%(15/58),溶解有效率为62.1%(36/58)。与无效组相比,有效组持续性心房颤动比例和LAD低于无效组,有效组LAEF和LAA-v高于无效组,差异有统计学意义(P<0.05)。对基线数据和各项超声指标进行多因素logistic回归分析显示,心房颤动类型、LAD、LAEF和LAA-v与抗凝疗效独立相关(P<0.05)。达比加群酯对心房颤动患者LAA血栓溶解有效,心房颤动类型、LAD、LAEF和LAA-v与抗凝疗效显著相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b36c/6039616/1cbd2b7431a4/medi-97-e11117-g001.jpg

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