摘要
目的评估皮下注射磺达肝癸钠用于心房颤动（房颤）导管消融术围术期抗凝治疗的疗效及安全性、对华法林的起效时间有无影响及在局部注射部位瘀斑的形成是否优于依诺肝素及达肝素。方法将射频导管消融术治疗房颤的患者随机分为依诺肝素组24例，达肝素组20例及磺达肝癸钠组50人。消融术前皮下注射依诺肝素、达肝素或磺达肝癸钠5-10d，消融术后皮下注射至少3-5d（同时应用华法林治疗），待国际标准化比率（INR）上升至1-8-2．0时停用。结果（1）三组患者基线特征的比较差异无统计学意义（P〉0．05）。（2）三组疗效性及安全性的比较：依诺肝素组、达肝素组、磺达肝癸钠组血栓栓塞事件发生率分别为0／24、0／20、1／50人，比较三组血栓栓塞率差异无统计学意义；三组均无大出血事件发生。（3）三组药物在华法林INR不同的达标时间例数上差异无统计学意义（P〉0．051。（4）三组患者注射部位瘀斑情况比较：用药7天时，磺达肝癸钠注射部位皮下瘀斑的发生率明显降低（磺达肝癸钠组、依诺肝素组、达肝素组无瘀斑患者所占比例分别为：0．66，0．21，0．15，P〈0．05），瘀斑长径明显减小（磺达肝癸钠组、依诺肝素组、达肝素组瘀斑长径分别为：0．7，2．3，3．3cm，P〈0．05），且优于依诺肝素及达肝素。结论与依诺肝素和达肝素组相比，磺达肝癸钠用于房颤射频导管消融术围术期抗凝治疗未增加严重出血及血栓栓塞，也不影响INR的达标时间，但可以减少注射部位皮下瘀斑的发生率和范围。
Objective To evaluate the efficacy and safety of subcutaneous injection of fondaparinux during perioperative period of radiofrequency catheter ablation of atrial albrillation （AF）, figure out whether it will affect the targeted time of INR after using warfarin, and compare with dalteparin and enoxaparin for ecchymosis effects at the injection sites. Methods Ninety-four AF patients undergoing catheter ablation were randomly divided into 3 groups, including 24 patients in enoxaparin group, 20 patients in dalteparin group, and 50 patients in fondaparinux group. Enoxaparin, dalteparin or fondaparinux was subcutaneously injected for 5-10 days before catheter ablation, and continued for at least 3-5 days after ablation before INR achieving the target of 1.8-2.0 under the use of oral warfarin. Results There was no statistical difference in baseline characteristics among three groups （P 〉 0.05）. The thromboembolic events were 0/24 patients in enoxaparin group, 0/20 in dalteparin group and 1/50 in fondaparinux group, and there was no statistical difference in the incidence of thromboembolic events among three groups. There was no serious bleeding events in all three groups. The time for achieving the targeted INR after ablation had no statistical difference among three groups （P 〉 0.05）. The incidence and the long diameter of ecchymosis in injection sites were significantly lower/less in fondaparinux group than in enoxaparin and dalteparin groups on the seventh day after injection of fondaparinux or LMWH （non-ecchymosis ratio： fondaparinux, 0.66; enoxaparin, 0.21; dalteparin, 0.15; P 〈 0.05; long diameter of ecchymosis： fondaparinux, 0.Tcm; enoxaparin, 2.3cm; dalteparin, 3.3cm; P 〈 0.05）. Conclusion Compared with enoxaparin and dalteparin, fondaparinux in perioperative anticoagulation therapy of catheter ablation of AF neither increases the major bleeding and thromboembolic events, nor affects the targeted time of INR after using warfarin. Fondaparinux could reduce the incidence and scope of ecchymosis in subcutaneous injection sites.
出处
《中华老年多器官疾病杂志》
2012年第2期94-98,共5页
Chinese Journal of Multiple Organ Diseases in the Elderly
关键词
心房颤动
导管消融术
磺达肝癸钠
抗凝药
低分子肝素
atrial fibrillation
catheter ablation
Fondaparinux
anticoagulants
low molecular weight heparin
