| ObjectiveWarfarin has some limitations in the treatment of atrial fibrillation catheter anticoagulation after radiofrequency ablation.Dabigatran as the second drug approved for anticoagulation treatment of atrial fibrillation,is an important choice for the anticoagulation treatment after radiofrequency ablation of atrial fibrillation.Currently,there are relatively few domestic and foreign studies.This study compared the therapeutic effects of dabigatran and warfarin in anticoagulation treatment after radiofrequency ablation of atrial fibrillation catheter,providing a theoretical basis for clinical selection of anticoagulation therapy.MethodsEighty patients who underwent radiofrequency catheter ablation for paroxysms of atrial fibrillation after anticoagulation treatment were randomly divided into the dabigatran group and the warfarin group.All patients were recieved radiofrequency catheter ablation.After the completion of preoperative indicators and examination,patients with CHA2DS2-VASc score ≤1 were injected with low molecular weight heparin sodium 4000 IU and q12 h subcutaneously for 3 days.Patients with CHA2DS2-VASc score ≥2 points were given anticoagulation drugs for 3 weeks before the operation.The observation group was given dabigatran ll0mg/ time,bid,and the control group was given warfarin 2.5mg/ time,qd.Warfarin dose was adjusted according to INR,and intraoperative heparinization was performed.The observation group was treated with ll0mg/ time and bid anticoagulation therapy after operation.The control group received warfarin before operation and continued to take the previous dose.For those who did not receive warfarin before operation,low-molecular-weight heparin sodium 4000IU/ql2 h hypodermic injection and oral warfarin 2.5mg/qd combined with anticoagulation for 5 days,then the low-molecularweight heparin sodium stopped while warfarin anticoagulation continued.INR was monitored and to adjust warfarin dose.All patients were followed up for 3 months.General data of patients were recorded,and changes in coagulation routine,blood routine,liver and kidney function indexes,as well as the occurrence of thromboembolic events,bleeding events,atrial fibrillation recurrence rate,other adverse reactions and mortality were compared between the two groups before,7 days after,15 days after,1 month after,and 3months after the operation.ResultsThere was no statistically significant difference in the general data between the two groups before treatment(P > 0.05).Influence of coagulation indicators: APTT and TT in the dabigatran group at 7,15,1and 3 days after the operation were significantly higher than those before the administration,and the difference was statistically significant(P<0.05).There was no significant change before and after the administration of the remaining indicators.APTT,PT,INR and TT in the warfarin group at 7 days,15 days,1 month and 3 months after the operation were significantly higher than those before the administration and the difference was statistically significant(P < 0.05).Compare the two groups,PT and INR of the warfarin group on 7,15,1 and 3 days after the operation were significantly higher than that of the dabigatran group at the same time period,and the difference was statistically significant(P<0.05).TT in the dabigatran group at 7,15,1 and 3 days after operation was significantly higher than that in the warfarin group and the difference was statistically significant(P<0.05).There was no significant difference in residual index(P > 0.05).Thromboembolic events: the incidence of thromboembolic events in the warfarin group(5.1%)was higher than that in the dabigatran group(2.7%),but the difference was not statistically significant(P > 0.05).Bleeding events: 1 case of cerebral hemorrhage occurred in the warfarin group,with an incidence rate of 2.6%.No significant bleeding events occurred in the dabigatran group,and the difference was not statistically significant(P > 0.05).The incidence of minor bleeding in the warfarin group(23.1%)was higher than the dabigatran group(8.1%),the difference was statistically significant(P<0.05).Effects of blood routine and liver and kidney function indexes: no significant changes were observed in the dabigatran group and warfarin group before and after treatment,and there was no statistically significant difference between the two groups(P > 0.05).Comparison of other adverse reactions: the incidence of other adverse reactions in the dabigatran group(10.8%)was slightly higher than the warfarin group(7.8%),but the difference was not statistically significant(P > 0.05).Recurrence rate of atrial fibrillation: the recurrence rate of atrial fibrillation in the dabigatran group(13.5%)was lower than the warfarin group(17.9%),and the difference between the two groups was not statistically significant(P>0.05).In the same group,the recurrence rate of atrial fibrillation with CHA2DS2-VASc score ≥ 3 points was significantly increased when compared with scores 2 and 1 points,and the difference was statistically significant(P<0.05).ConclusionIn the anticoagulation treatment after radiofrequency ablation of catheter for nonvalvular atrial fibrillation,compared with warfarin,the efficacy of dabigatran group was positive,which can reduce the risk of thromboembolism in patients,and the effect is not inferior to warfarin,without the need to monitor INR,which indicates higher safety.The higher the CHA2DS2-VASc score,the higher the recurrence rate of atrial fibrillation. |
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