新型非维生素 K 拮抗剂口服抗凝剂在左心耳封堵术后的应用：临床随访的初步结果。
The Use of Novel Non-Vitamin K Antagonist Oral Anticoagulants Following Closure of the Left Atrial Appendage: Preliminary Results of Clinical Follow-Up.
机构信息
Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230000, People's Republic of China.
出版信息
Drug Des Devel Ther. 2021 Mar 9;15:1067-1073. doi: 10.2147/DDDT.S293812. eCollection 2021.
OBJECTIVE
The aim of this study was to investigate the safety and efficacy of using novel non-vitamin K antagonist oral anticoagulants (NOACs) for anticoagulation following left atrial appendage closure (LAAC).
METHODS
A total of 70 patients with non-valvular atrial fibrillation (NVAF) were enrolled in this study. All patients underwent successful LAAC between November 2018 and September 2019 in the Department of Cardiology of the First Affiliated Hospital of the University of Science and Technology of China. All patients subsequently completed a 45-day postoperative follow-up period. Patients were grouped according to the postoperative anticoagulation regimen they received: there were 40 patients in the NOACs group and 30 patients in the warfarin group. Baseline clinical data, intraoperative data, and short-term postoperative follow-up data were collected and the two groups were compared.
RESULTS
The intraoperative results showed no statistical difference between the two groups in respect of the occlusion rate, the compression ratio of the occluder, the volume of pericardial effusion, or the incidence of the following: residual shunts, device-related thromboses (DRT), stroke, and pericardial effusion ( > 0.05 in all cases). The residual shunt volume in the NOACs group was significantly smaller than that in the warfarin group ( = 0.04). During the 45-day postoperative follow-up period, there was no statistical difference between the two groups in respect of the residual shunt volume, or the incidence of DRT, ischemic stroke and cerebral hemorrhage ( > 0.05 in all cases). Compared with the warfarin group, the residual shunt volume was significantly reduced in the NOACs group ( = 0.03). The incidence of minor hemorrhage and the total hemorrhage incidence in the NOACs group were significantly lower than those in the warfarin group (5% vs 30%, = 0.004, and 5% vs 33.3%, = 0.002, respectively).
CONCLUSION
In this study, the use of NOACs for postoperative anticoagulation therapy following LAAC did not increase the risk of embolization or hemorrhage during the short-term follow-up period.
目的
本研究旨在探讨新型非维生素 K 拮抗剂口服抗凝剂（NOACs）在左心耳封堵（LAAC）后抗凝的安全性和有效性。
方法
本研究共纳入 70 例非瓣膜性心房颤动（NVAF）患者。所有患者于 2018 年 11 月至 2019 年 9 月在我院心内科成功接受 LAAC。所有患者均完成术后 45 天的随访。根据术后抗凝方案将患者分为两组：NOACs 组 40 例，华法林组 30 例。收集两组患者的基线临床资料、术中资料和短期术后随访资料，并进行比较。
结果
术中结果显示，两组患者的封堵成功率、封堵器的压缩比、心包积液量、残余分流、器械相关血栓（DRT）、卒中和心包积液发生率（均>0.05）差异均无统计学意义。NOACs 组的残余分流体积明显小于华法林组（=0.04）。在 45 天的术后随访期间，两组患者的残余分流体积、DRT、缺血性卒中和脑出血发生率（均>0.05）差异均无统计学意义。与华法林组相比，NOACs 组的残余分流体积明显减少（=0.03）。NOACs 组的轻微出血和总出血发生率明显低于华法林组（5% vs 30%，=0.004，5% vs 33.3%，=0.002）。
结论
本研究表明，LAAC 术后使用 NOACs 进行抗凝治疗在短期随访期间不会增加栓塞或出血的风险。
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