Objective: Differences in the activated coagulation time (ACT) during ablation and adequate heparin dosing were observed among atrial fibrillation (AF) patients undergoing AF catheter ablation receiving different anticoagulation therapies and the suitable heparin dosing during ablation among patients treated with different anticoagulation therapies was explored. Methods: Patients who received warfarin (n=100), low-molecular-weight heparin (n=100), dabigatran etexilate (n=98, 110 mg, Bid) and rivaroxaban (n=48, 20 mg, Qd) were included. All of them underwent the first AF ablation during January 2016 to December 2017 and patients with hepatic and renal dysfunction were excluded. Initial bolus heparin (100 U/kg, intravenous) was applied to all patients. Additional heparin dosage was added according to the ACT, which was measured in 15-minute interval to maintain the ACT within 250-350 seconds until the end of ablation. Patient characteristics, ACT and complications were compared among various groups. Results: The baseline general characteristics among patients were similar. The baseline ACTs in the dabigatran groups were significantly longer than those in the rivaroxaban group ((133±36) seconds vs. (113±22) seconds, P<0.05). The 15 min ACT in the warfarin group was longer than in the dabigatran group ((259±56) seconds vs. (243±43) seconds, P<0.05). The 15-minute ACTs were significantly longer in the warfarin ((259±56) seconds) and dabigatran ((243±43) seconds) groups compare with low-molecular-weight heparin group ((224±40) seconds) and rivaroxaban group ((226±32) seconds) (all P<0.05). The same trend was also observed in the rate of reaching ACT goal after initial-standard-dosage of heparin (warfarin (53%, 53/100), dabigatran (45%,44/98), low-molecular-weight heparin (28%,28/100), rivaroxaban (23%,11/48), P<0.05). The 1 hour ACT in the warfarin group ((254±49) seconds) was significantly longer than the other three groups (dabigatran (233±33) seconds, low-molecular-weight heparin (226±34) seconds, rivaroxaban (231±30) seconds, all P<0.01). The rate of reaching ACT goal at 1 hour were significantly higher in the warfarin group (66%,35/53) than in the dabigatran group (41%,18/44), and rivaroxaban group (27%,3/11) (all P<0.05). The total heparin required was significantly higher in rivaroxaban group than in the dabigatran and warfarin groups (all P<0.05). During the perioperative period, no patient exhibited any thromboembolic complications, and only a few minor bleeding complications was observed among patients, which was similar between the four groups (P>0.05). Conclusion: Higher dosage of heparin is required during AF ablation to achieve the satisfactory anticoagulant intensity for AF patients under dabigatran etexilate (110 mg, Bid), low-molecular-weight heparin and rivaroxaban (20 mg, Qd) anticoagulation therapy before AF ablation.
目的： 研究术前不同抗凝方案对心房颤动（房颤）射频消融术中活化凝血时间（ACT）等的影响，评价术中经验性肝素用量是否适用于术前不同抗凝方案的房颤患者。 方法： 回顾性分析2016年1月至2017年12月于大连医科大学附属第一医院首次接受房颤射频消融术、无严重肝肾功能不全患者的临床资料，依照术前抗凝方案将患者分为4组：华法林组（100例）、达比加群（110 mg，2次/d）组（98例）、低分子肝素组（100例）和利伐沙班（20 mg，1次/d）组（48例）。术中4组患者均给予了100 U/kg首剂肝素，每15 min监测ACT，依照ACT值追加适量肝素，维持ACT在250~350 s，直至手术结束。对4组观察指标进行统计学分析。 结果： 4组患者的年龄、性别、合并疾病、术前服用非抗凝药等基线资料差异均无统计学意义。达比加群组的基础ACT为（133±36）s，长于利伐沙班组的（113±22）s（P<0.05）；华法林组15 min ACT为（259±56）s，长于达比加群组的（243±43）s（P<0.05）；与低分子肝素组的（224±40）s及利伐沙班组的（226±32）s比较，华法林组及达比加群组的15 min ACT更长（P均<0.05），而且首剂达标的比率更高[华法林、达比加群、低分子肝素和利伐沙班组分别为53%（53/100）、45%（44/98）、28%（28/100）、23%（11/48），P均<0.05]。华法林组1 h ACT为（254±49）s，长于其他3个组[分别为（233±33）、（226±34）和（231±30）s，P均<0.01]；华法林组1 h达标率为66%（35/53），高于达比加群组的41%（18/44）及利伐沙班组的27%（3/11）（P均<0.05）；利伐沙班组所用总肝素剂量/kg明显多于华法林组及达比加群组（P均<0.05）；4组患者在围手术期均无血栓栓塞事件发生；各组有少量的出血事件发生，但差异无统计学意义（P>0.05）。 结论： 对于术前应用达比加群（110 mg，2次/d）、低分子肝素以及利伐沙班（20 mg，1次/d）抗凝的房颤患者，应尝试增加术中首剂肝素剂量及追加剂量，以达到与华法林相近的、指南推荐的术中抗凝强度。.
Keywords: Anticoagulants; Atrial fibrillation; Catheter ablation; Heparin.