Anticoagulation Efficacy And Safety Of Fondaparinux During Perioperative Period Of Radiofrequency Catheter Ablationof Atrial Fibrillation Compared With LMWH

Objective:To evaluate the efficacy and safety of subcutaneous injection offondaparinux compared with low molecular weight heparin (LMWH) duringperioperative period of radiofrequency catheter ablation of atrial aibrillation (AF),whether it will affect the targeted time of INR after using warfarin and ecchymosis at theinjection site whether or not will exceed dalteparin and enoxaparin.Methods:Ninety-four AF patients undergoing catheter ablation were randomlydivided into3groups, including24patients in enoxaparin group,20patients indalteparin group, and50patients in fondaparinux group. Enoxaparin, dalteparin orfondaparinux was subcutaneously injected for5-10days before catheter ablation, andcontinued for at least3-5days after ablation before INR achieving the target of1.8-2.0underthe use of oral warfarin. All of the patients must choose the same kind of anticoagulationdrugs. The targeted time of INR after using warfarin control between2and3.Results:1. There were no statistical differences in baseline characterisitics amongthree groups (P>0.05).2.Compare efficacy and safety of three groups:(1) Theefficacyof drug: the thromboembolic events which including mortality, cerebralembolism, pulmonary embolism and systemic embolism were0/24patients inenoxaparin group,0/20in dalteparin group and1/50in fondaparinux group.Infondaparinux group one patient in the next day appeared the left limb flexibility and lefthand numbness.According to the result of CT the patient was diagnosed:cerebralembolism.Continued to give anticoagulant therapy, the symptoms of patient disappearedin the third day after surgery and did not occurred in the follow-up these symptoms. There was no statistical difference in the incidence of thromboembolic events amongthree groups.(2) The safety of drug: the results showed that there were no seriousbleeding events in all the three groups. Fondaparinux,2.5mg Once-daily subcutaneous,is at least as effective and safe as enoxaparin and dalteparin.3. The time for achievingthe targeted INR focused on the fourth day to the seventh day. The totality of threegroups respectively were34patients,19patients,17patients,12patients from the fourthday to the seventh day. The drugs of three groups in the time for achieving the targetedINR after ablation had no statistically differences (P>0.05).4.Compared the incidenceand the long diameter of ecchymosis in injection sites in three groups: the group ofenoxaparin in no ecchymosis、 mild、moderate、severe are5、10、3、3，the averageof ecchymosis diameter was2.3cm; the groups of dalteparin were3,5,4,8and theaverage diameter was3.3cm; fondaparinux groups were:33,13,2,2and the averagediameter was0.7cm.There was statistically significant in three groups (P <0.05).Respectively compared with each of the two groups, there was no significant differencein enoxaparin group and dalteparin group (P>0.05); in enoxaparin and fondaparinuxgroups there was statistically significant difference (P <0.05), comparing withfondaparinux and dalteparin groups,there was statistically significant difference (P<0.05) The incidence and the long diameter of ecchymosis in injection sites weresignificantly lower in fondaparinux group than in enoxaparin and dalteparin groups onthe seventh day after injection of fondaparinux or LMWH.Conclusion Compared with enoxaparin and dalteparin, fondaparinux,2.5mgOnce-daily subcutaneous,in perioperative anticoagulation therapy of catheter ablation ofAF would not increase the major bleeding and thromboembolic events, and also wouldnot affect the targeted time of INR after using warfarin. Fondaparinux could reduce theincidence and scope of ecchymosis in subcutaneous injection sites.