Department of Cardiovascular Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Cardiovascular Medicine, Wuhan No. 1 Hospital, Wuhan, Hubei, China.
Am J Cardiovasc Drugs. 2022 Sep;22(5):557-565. doi: 10.1007/s40256-022-00536-7. Epub 2022 Jun 18.
This study aimed to investigate the effectiveness and safety of idarucizumab for periprocedural cardiac tamponade after catheter ablation of atrial fibrillation (AF) in patients treated with dabigatran.
We retrospectively studied 28 patients who received catheter ablation of AF and developed periprocedural cardiac tamponade. Patients were divided into two groups: control group (14 cases) and the study group (14 cases). Patients in the control group were administered warfarin bridged with low molecular weight heparin, while patients in the study group were given dabigatran for anticoagulation. Heparin was used for anticoagulation during surgery in both groups. Patients with cardiac tamponade in control group was reversed with protamine and the ones in study group were given protamine and idarucizumab. In the two groups, operative time, time to resume anticoagulation, bleeding time, length of hospital stay, hemodynamic parameters, coagulation function parameters, number of patients undergoing thoracotomy for hemostasis, pericardiocentesis drainage volume, and pericardial drainage retention time were recorded.
There was no statistical difference in operative time and length of hospital stay between the two groups (p > 0.05); however, time to resume anticoagulation and bleeding time were significantly lower in the study group than in the control group, with a statistical difference (p < 0.05). After anticoagulation therapy, there was no apparent change and no statistical difference in the hemodynamic parameters and SaO between the two groups (p > 0.05). The pericardial drainage volume retention time was significantly shorter in the study group than in the control group, with a statistical difference (p < 0.05).
Idarucizumab can rapidly and effectively reverse the anticoagulant effect of dabigatran in patients with AF who have periprocedural cardiac tamponade after catheter ablation.
本研究旨在探讨达比加群酯治疗患者经导管消融心房颤动（AF）后围手术期心脏压塞时，使用依达鲁单抗的有效性和安全性。
我们回顾性研究了 28 例接受 AF 导管消融并发生围手术期心脏压塞的患者。患者分为两组：对照组（14 例）和研究组（14 例）。对照组患者给予华法林桥接低分子肝素，研究组患者给予达比加群酯抗凝。两组均在手术中使用肝素抗凝。对照组心脏压塞患者用鱼精蛋白逆转，研究组患者用鱼精蛋白和依达鲁单抗逆转。记录两组患者的手术时间、恢复抗凝时间、出血时间、住院时间、血流动力学参数、凝血功能参数、需要开胸止血的患者数量、心包穿刺引流量和心包引流保留时间。
两组患者的手术时间和住院时间无统计学差异（p>0.05）；但研究组患者的恢复抗凝时间和出血时间明显短于对照组，有统计学差异（p<0.05）。抗凝治疗后，两组患者的血流动力学参数和 SaO 均无明显变化，无统计学差异（p>0.05）。研究组患者心包引流保留时间明显短于对照组，有统计学差异（p<0.05）。
依达鲁单抗可快速有效地逆转达比加群酯治疗 AF 患者经导管消融后围手术期心脏压塞时的抗凝作用。
