心房颤动消融术后应用达比加群酯和华法林抗凝疗效观察

目的研究达比加群酯在心房颤动(简称房颤)射频消融术后抗凝治疗的有效性及安全性。方法选择已行导管射频消融术治疗的房颤患者,按应用口服抗凝药物的不同分为华法林组和达比加群酯组。收集所有患者的年龄、性别、房颤类型、凝血及肝肾功能等基本指标。所有患者符合入选及排除标准,均于射频消融术后应用达比加群酯或华法林行抗凝治疗。对患者进行3个月随访,以血栓性终点与安全性终点为研究终点,对比两组患者的临床疗效和出血风险。结果华法林组133例,达比加群酯组98例。两组间性别、年龄、房颤类型、伴随疾病及吸烟史等无差异。与华法林组比较,达比加群酯组血栓栓塞事件发生率无差异(4.08%vs 4.51%,P0.05)。严重出血事件更低(1.02%vs 6.77%,P0.05)。达比加群酯组及华法林组均有少量出血事件发生,两组发生率无差异(31.63%vs 33.08,P0.05)。结论达比加群酯对房颤射频消融术后抗凝治疗的效果与华法林相当,但安全性更高。     

新型口服抗凝药物研究进展

<正>2001年ATRIA研究报道,年龄<60岁心房颤动的患病率为1%,而年龄>80岁,患病率则可增至10%。心房颤动可使栓塞或脑卒中风险增加5倍,每年绝对风险为1%～20%。《中国心血管病报告2010》指出,我国心房颤动患者脑卒中患病率明显高于非心房颤动人群。华法林虽可降低心房颤动患者脑卒中的风险达2/3,但是,它也有一定的局限性。目前,3种新型抗凝药物引起临     

新型口服抗凝药防治急性静脉血栓栓塞症的研究进展

急性静脉血栓栓塞症(AVTE)发病率较高,是临床常见的三大致死性血管疾病之一。抗凝治疗是防治AVTE的重要措施,传统抗凝药物包括肠外抗凝药物(如普通肝素及低分子肝素等)和维生素K拮抗剂,但其临床应用受限。近年来,新型口服抗凝药(NOACs)防治AVTE的有效性和安全性成为临床研究热点之一。本文对NOACs在AVTE治疗中的作用、NOACs的分类及其临床推荐方案、特殊情况下NOACs的应用、NOACs的实验室定性和定量分析、逆转NOACs相关性出血药物方面的最新研究进展进行综述。     

达比加群酯在非瓣膜性房颤抗凝治疗中的应用

目的比较达比加群酯和华法林在非瓣膜性心房颤动患者的抗凝治疗过程中疗效和安全性。方法对2013年3月—2014年2月收治的54例住院及门诊随诊房颤患者的临床资料进行回顾性分析。结果华法林组31例中发生脑栓塞2例,死亡1例,死亡原因为心力衰竭,轻微出血5例。达比加群酯组23例中发生脑栓塞1例,轻微出血1例。结论达比加群酯在非瓣膜性房颤抗凝治疗中可有效进行抗凝治疗,并有效提高患者依从性。     

美国心房颤动指南的最新更新——聚焦达比加群酯

<正>晚近,ACCF/AHA/HRS依据RE-LY研究心房颤动(简称房颤)长期抗凝治疗随机评估研究的结果,对2011版美国房颤患者管理指南进一步做出了更新,本次更新主要关注于一种近期被美国FDA批准的新型抗栓药物——达比加群酯(dabigatran etexilate)在房颤患者中的应用。     

新型口服抗凝药相关出血的研究进展

新型口服抗凝药物(Novel oral anticoagulants,NOACs)包括直接凝血酶抑制剂(达比加群)和直接Xa因子抑制剂(利伐沙班、阿哌沙班),较传统抗凝药物(例如维生素K拮抗剂华法林、低分子量肝素)更有效且安全。由于它们特殊的作用机制和特异性拮抗药物的匮乏,给临床医师在处理相关出血情况时造成了困难。本文将针对NOACs相关出血风险、监测及出血的相关危险因素、临床处理等作一综述。     

达比加群酯在非瓣膜性心房颤动抗凝治疗中的作用及进展

非瓣膜性心房颤动(NVAf)是最常见的心律失常之一,是心脏病学界仍待攻克的世界性难题。据统计,正常人群中脑卒中发生率为1%,心房颤动(房颤)患者发生脑卒中的危险为正常人群的5~7倍,而且房颤引起的脑卒中后果更为严重,是房颤致残致死的最重要原因。随着人类社会疾病谱的变化,房颤     

心房颤动导管消融围手术期患者应用达比加群酯与华法林的疗效和安全性观察

目的比较达比加群酯和华法林用于阵发性心房颤动(简称房颤)患者导管消融围手术期的疗效和安全性。方法入选本科行房颤导管消融手术的阵发性房颤患者60例,随机分为华法林组与达比加群酯组,每组30例。记录患者的一般情况,评估栓塞和出血风险。两组患者分别参照指南给予术前、术中及术后的抗凝治疗。观察患者的围手术期死亡、出血和栓塞事件、不良反应和住院时间。结果两组患者的年龄、性别组成、伴随疾病及栓塞危险评分无显著差异。两组患者无围手术期死亡与血栓栓塞事件。华法林组的围手术期出血事件明显多于达比加群酯组[13.3%(4/30)vs 3.3%(1/30),P0.05],大出血1例,发生于华法林组,为穿刺部位血肿导致输血。术后住院时间华法林组明显长于达比加群酯组[(4.1±1.7)d vs(2.1±0.3)d,P0.05]。达比加群酯组常见的不良反应是腹痛,有5例(16.7%)出现,仅1例不能耐受而改服华法林。结论房颤导管消融围手术期应用达比加群酯,可能缩短住院时间,减少出血事件,较多见的不良反应是轻微的胃肠道症状。     

新型口服抗凝药在心房颤动相关认知障碍中的作用

正1新型口服抗凝药的概述针对心房颤动(房颤)高危人群(CHA2DS2-VASc≥2分)预防远期不良事件(血栓栓塞、脑卒中、猝死等),抗凝治疗有着不可替代的作用。目前在非瓣膜病性房颤患者中,传统抗凝药物华法林由于起效慢、常受食物及生活方式的影响、需长期监测国际标准化比值(INR)等原因,临床上已经逐渐被新型口服抗凝药取代。目前新型口服抗凝药主要分为2大类:直接Ⅹa因子抑制剂(如利伐沙班)和直接凝血酶抑制剂(如达比加群),两者无须监测抗凝活性,与药物、食物     

新型口服抗凝药的临床应用

新型口服抗凝药物(NOAC) 凭借其无需频繁监测凝血指标、药物食物相互作用较少、出血等并发症发生率较 低等优点,在抗凝治疗中的地位不断上升。目前,NOAC 已被广泛应用于非瓣膜性心房颤动、静脉血栓栓塞等病变 的抗凝治疗之中。然而,针对不同的临床情况,NOAC 的应用亦有其特点。文章将从NOAC 的特征、临床适应证、 药物间的转换及出血并发症的处理等方面阐述NOAC 的应用。     

心房颤动抗凝治疗进展

心房颤动是最常见的心律失常之一,心房颤动患者脑卒中发生风险显著增高,且较其他原因所致的脑卒中有更高的致残率与病死率,故预防脑卒中是心房颤动治疗的重要环节,抗凝治疗在心房颤动患者管理中的地位及重要性逐渐提高.近年来,在心房颤动抗凝治疗方面有重要进展,现对心房颤动患者脑卒中与出血风险评估、抗凝策略选择及抗凝药物研究最新进展进行综述.     

Clinical use of new oral anticoagulant drugs: dabigatran and rivaroxaban

Orally active small molecules that selectively and specifically inhibit coagulation serine proteases have been developed for clinical use. For some patients these oral direct inhibitors (ODIs) offer substantial benefits over oral vitamin K antagonists (VKA). However, for the majority of patients with good anticoagulant control with VKAs the advantages of the ODIs are primarily convenience and few drug interactions. The drugs are prescribed at fixed dose without the need for monitoring or dose adjustment in the majority of patients and the rapid onset of anticoagulation and short half‐life make initiation and interruption of anticoagulation considerably easier than with VKAs. As yet, specific antidotes to ODIs are not available for clinical use but these are in development as rapid reversal agents. As with all anticoagulants produced so far, there is a correlation between intensity of anticoagulation and bleeding. Consequently, the need to consider the balance of benefit and risk in each individual patient is no less important than with VKA therapy. Dabigatran and rivaroxaban have been chosen for this review as examples of a thrombin inhibitor and an inhibitor of factor Xa respectively. The clinical application of these drugs is the focus of the review.     

新型抗凝药与华法林对非瓣膜性心房颤动患者抗凝效果的临床评价

[目的]研究利伐沙班、达比加群酯与华法林对非瓣膜性心房颤动抗凝效果。[方法]收集心内科接收的120例非瓣膜性心房颤动住院患者为研究对象,均服用单一抗凝药物,分为华法林组(40例)、利伐沙班组(40例)和达比加群酯组(40例),接受药物治疗6个月,比较治疗期间栓塞事件、出血事件发生率和血常规、肝肾功能及血栓弹力图指标情况。[结果]治疗6个月后,利伐沙班组和达比加群酯组栓塞事件发生率明显低于华法林组(P<0.05),而利伐沙班组与达比加群酯组比较差异无显著性(P>0.05);三组出血事件发生率、治疗前及治疗后6个月患者血常规指标(白细胞计数、血小板计数、血红蛋白)、肝肾功能指标(血清肌酐、谷丙转氨酶、血尿素氮)比较差异无显著性(P>0.05);治疗6个月后利伐沙班组与达比加群酯组血栓弹力图指标R值、K值、MA值均明显高于华法林组(P<0.05),但利伐沙班组与达比加群酯组比较差异无显著性(P>0.05)。[结论]利伐沙班、达比加群酯治疗非瓣膜性心房颤动相比华法林具有更优的抗凝效果,降低栓塞事件的发生,且对肝肾功能及血常规无明显影响,安全性高。     

Novel anticoagulants for stroke prevention in atrial fibrillation: current clinical evidence and future developments

Atrial fibrillation (AF) is the most common cardiac rhythm disorder and a major risk factor for ischemic stroke. Antithrombotic therapy using aspirin or vitamin K antagonists (VKA) is currently prescribed for prevention for ischemic stroke in patients with AF. A narrow therapeutic range and the need of regular monitoring of its anticoagulatory effect impair effectiveness and safety of VKA, causing a need for alternative anticoagulant drugs. Recently developed anticoagulants include direct thrombin antagonists such as dabigatran or factor Xa inhibitors such as rivaroxaban, apixaban, betrixaban, and edoxaban. Currently, data from a phase III clinical trial are available for dabigatran only, which show the direct thrombin antagonist to be at least noninferior in efficacy to VKA for the prevention of stroke and systemic embolism in patients with AF. This review focuses on current advances in the development of directly acting oral anticoagulant drugs and their potential to replace the VKA class of drugs in patients with AF.     

心房颤动口服药物治疗的新选择

近年来,尽管导管消融和外科手术在心房颤动(房颤)的治疗中取得了令人瞩目的进展,但并未广泛应用,药物治疗依然处于首要地位。由于传统抗凝药和抗心律失常药的自身局限性,该领域新型药物的开发成为研究热点,而近年来多种新型口服药物的开发研制和临床试验的成功,为房颤的药物治疗带来新的希望。本文对此加以综述。     

Second Copenhagen Atrial Fibrillation,Aspirin, and Anticoagulant Therapy Study (AFASAK 2): Methods and design

Background: Seven randomized trials have demonstrated that anticoagulant therapy is effective for primary and secondary prevention of stroke and other thromboembolic events in patients with chronic nonvalvular atrial fibrillation. The effect of aspirin is still not clarified. Conventional anticoagulant therapy is inconvenient as a primary preventive therapy as it requires frequent blood tests and implies a risk of bleeding complications. Purpose and methods: The Second Copenhagen Atrial Fibrillation, Aspirin and Anticoagulant Therapy Study (The AFASAK 2 study) is a randomized, one center, primary prevention trial. Its purpose is to investigate the effect of four antithrombotic regimens in patients with atrial fibrillation (1) fixed dose warfarin 1.25 mg per day, (2) a combination of warfarin 1.25 mg per day and aspirin 300 mg per day, (3) aspirin 300 mg per day, and (4) conventional warfarin therapy (INR 2.0–3.0). The primary endpoint is a stroke or a thromboembolic event in viscera or extremities. Secondary endpoints are transient ischemic attack, myocardial infarction, or death. The study will evaluate outcome events on intention-to-treat principles. The rate of bleeding complications is evaluated. The aim is to obtain an antithrombotic therapy for patients with nonvalvular atrial fibrillation that is effective, safe, easy to administer, and inexpensive. The methods and design of the study are presented in this paper.     

Acute Brachial Arterial Embolic Occlusion Following Anticoagulant Discontinuation in a Renal Biopsy of a Nephrotic Syndrome Patient

A 73-year-old woman with atrial fibrillation treated with rivaroxaban was hospitalized for nephrotic syndrome. After discontinuation of rivaroxaban to lower the risk of hemorrhagic events, a renal biopsy was performed. Rivaroxaban was scheduled to resume a week after the biopsy to prevent renal hemorrhaging. However, she developed acute brachial arterial embolic occlusion and mural thrombosis in the abdominal aorta before resuming rivaroxaban. If immune-mediated renal diseases are suspected in anticoagulated patients at a risk of thrombotic events, physicians should consider initiating glucocorticoid therapy without a renal biopsy in order to avoid hemorrhagic and thrombotic events.