【摘要】 目的:探讨射频消融术后联用胺碘酮对非瓣膜性心房颤动(房颤)患者直接口服抗凝剂(DOAC)抗凝效果的影响。方法:回顾性分析某三甲医院2012年1月至2018年7月非瓣膜性房颤患者的病历资料,筛选出射频消融术后采用利伐沙班或达比加群抗凝的患者,根据是否联用胺碘酮将患者分为无胺碘酮组(n=41)和胺碘酮组(n=188),评估联用胺碘酮是否影响患者转归和临床事件的发生。结果:两组患者年龄、性别、体质量指数(BMI)、伴随疾病、凝血指标均无统计学差异。应用DOAC至少1个月,胺碘酮组凝血酶原时间(PT)较无胺碘酮组明显延长[(12.09±0.49)s对(13.15±1.89)s,P=0.001],胺碘酮组国际标准化比值(INR)较无胺碘酮组明显增大(1.05±0.04对1.14±0.16,P=0.001)。两组主要安全性终点事件(颅内出血)和次要安全性终点事件(包括皮肤出血、胃肠道出血和其他出血事件)发生率的差异无统计学意义。在随访期间,无胺碘酮组没有发生胃肠道出血,胺碘酮组胃肠道出血6例(3.19%)。结论:射频消融术后联用胺碘酮可能增强利伐沙班或达比加群的抗凝效果,需关注胺碘酮增加利伐沙班或达比加群使用者的消化道出血风险。更多还原

【Abstract】 Objective:To explore the effect of amiodarone on the anticoagulation of direct oral anticoagulant(DOAC) in patients with non-valvular atrial fibrillation after radiofrequency ablation. Methods:The medical records of patients with non-valvular atrial fibrillation who treated with rivaroxaban or dabigatran after radiofrequency ablation from January 2012 to July 2018 in a tertiary hospital, were retrospectively analyzed. The patients were divided into the amiodarone-free group(n=41) and amiodarone group(n=188) to evaluate whether the amiodarone could affect the outcomes and incidence of clinical events. Results:There was no statistically significant difference between the two groups in age, gender, body mass index(BMI), concomitant diseases and coagulation indexes. After treatment with DOAC for at least one month, the prothrombin time in the amiodarone group was significantly longer than that of the amiodarone-free group((12.09±0.49) s vs.(13.15±1.89) s, P= 0.001), and the international normalized ratio in the amiodarone group was significantly higher than that of the amiodarone-free group(1.05±0.04 vs. 1.14±0.16, P=0.001). There was no case of gastrointestinal bleeding in the amiodarone group, while 6 cases(3.19%) in the amiodarone group during follow-up. Conclusions:Amiodarone may enhance the anticoagulant effect of rivaroxaban or dabigatran in patients with atrial fibrillation after radiofrequency ablation, but should pay attention to the risk of gastrointestinal bleeding events.更多还原