[1]金 灿,罗 俊,武英彪,等.心房颤动伴慢性肾脏病患者经皮左心耳封堵术后抗栓治疗方案研究[J].介入放射学杂志,2020,29(12):1187-1190.
　JIN Can,LUO Jun,WU Yingbiao,et al.Antithrombotic therapeutic regimens for atrial fibrillation patients with chronic kidney disease after receiving left atrial appendage closure： a clinical study[J].journal interventional radiology,2020,29(12):1187-1190.
点击复制

心房颤动伴慢性肾脏病患者经皮左心耳封堵术后抗栓治疗方案研究()

PDF下载中关闭

分享到：

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
29
期数:
2020年12
页码:
1187-1190
栏目:
心脏介入
出版日期:
2020-12-25

文章信息/Info

Title:
Antithrombotic therapeutic regimens for atrial fibrillation patients with chronic kidney disease after receiving left atrial appendage closure： a clinical study
作者:
金 灿;  罗 俊;  武英彪;  朱 茜;  方 明;  王赛华;  丛欣鹏;  王雪君;  王温慧;  宁忠平
Author(s):
JIN Can;  LUO Jun;  WU Yingbiao;  ZHU Qian;  FANG Ming;  WANG Saihua;  CONG Xinpeng;  WANG Xuejun;  WANG Wenhui;  NING Zhongping.
Department of Cardiology， Affiliated Zhoupu Hospital of Shanghai University of Medicine and Health Sciences， Shanghai 201318， China
关键词:
【关键词】 心房颤动;  左心耳封堵术;  慢性肾脏病;  抗血栓治疗
文献标志码:
A
摘要:
【摘要】 目的 探讨非瓣膜性心房颤动（房颤）伴慢性肾脏病（CKD）患者经皮左心耳封堵术（LAAC）后最佳抗栓治疗方案。 方法 对2018年1月至2019年2月于上海周浦医院接受LAAC治疗的68例非瓣膜性房颤伴CKD患者进行单中心回顾性分析。其中，38例LAAC术后服用华法林至少45 d（A组），30例术后服用双联抗血小板治疗6个月（B组）。观察两组患者围术期以及术后3、6、12 个月随访期装置相关血栓（DRT）、血栓栓塞事件和大出血事件发生率。 结果 两组患者年龄、性别、永久性房颤、伴高血压、伴糖尿病、伴冠心病、伴心力衰竭、脑卒中史、CHA2DS2-VASc评分、HAS-BLED评分等基线资料差异均无统计学意义（P＞0.05）。两组患者LAAC术均获成功。两组患者围手术期7 d内心脏压塞、血栓栓塞及大出血事件发生率差异均无统计学意义（P＞0.05）；术后45～60 d DRT、血栓栓塞、大出血事件及死亡发生率差异均无统计学意义（P＞0.05）；术后1年血栓栓塞、大出血事件及死亡发生率差异均无统计学意义（P＞0.05）。 结论 房颤伴CKD患者经皮LAAC术后双联抗血小板治疗，不增加近期DRT、血栓栓塞及大出血事件风险。

参考文献/References:

［1］ Kirchhof P， Benussi S， Kotecha D， et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS［J］. Eur Heart J， 2016， 37： 2893- 2962.
［2］ Bonde A， Lip G， Kamper AL， et al. Net clinical benefit of antithrombotic therapy in patients with atrial fibrillation and chronic kidney disease［J］. J Am Coll Cardiol， 2014， 64： 2471- 2482.
［3］ Go AS， Fang MC， Udaltsova N， et al. Impact of proteinuria and glomerular filtration rate on risk of thromboembolism in atrial fibrillation： the anticoagulation and risk factors in atrial fibrillation（ATRIA）study［J］. Circulation， 2009， 119： 1363- 1369.
［4］ Hart RG， Eikelboom JW， Brimble KS， et al. Stroke prevention in atrial fibrillation patients with chronic kidney disease［J］. Can J Cardiol， 2013， 29： S71- S78.
［5］ Reinecke H， Engelbertz C， Schabitz WR. Preventing stroke in patients with chronic kidney disease and atrial fibrillation： benefit and risks of old and new oral anticoagulants［J］. Stroke， 2013， 44： 2935- 2941.
［6］ Levey AS， de Jong PE， Coresh J， et al. The definition，classifi-cation， and prognosis of chronic kidney disease： a KDIGO controversies conference report［J］. Kidney Int， 2011， 80， 17- 28.
［7］ Levey AS， Bosch JP， Lewis JB， et al. A more accurate method to estimate glomerular filtration rate from serum creatinine： a new prediction equation. Modification of diet in Renal Disease Study Group［J］. Ann Intern Med， 1999， 130：461- 470.
［8］ 汤学超，白 元，张志钢，等． 左心耳封堵器临床研究进展［J］．介入放射学杂志， 2017， 26：281- 284．
［9］ Holmes DR， Reddy VY， Turi ZG， et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation： a randomised non- inferiority trial［J］. Lancet， 2009， 374： 534- 542.
［10］ Holmes DR Jr， Kar S， Price MJ， et al. Prospective randomized evaluation of the watchman left atrial appendage closure device in patients with atrial fibrillation versus longterm warfarin in the therapy： the PREVAL trial［J］. J Am Cillcardiol， 2014， 64： 1- 12.
［11］ 周 勇，蒋逸风． 经皮穿刺左心耳闭合装置的研制及临床应用［J］． 介入放射学杂志， 2013， 22：698- 700．
［12］ Xue X， Jiang L， Duenninger E， et al. Impact of chronic kidney disease on watchman implantation：experience with 300 consecutive left atrial appendage closures at a single center［J］. Heart Vessels， 2018， 33：1068- 1075.
［13］ Kefer J， Tzikas A， Freixa X， et al. Impact of chronic kidney disease on left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation［J］. Int J Cardiol， 2016， 207： 335- 340.
［14］ Cohen JA， Heist EK， Galvin J， et al. A comparison of postprocedural anticoagulation in high‐risk patients undergoing WATCHMAN device implantation［J］. Pacing Clin Electrophysiol， 2019， 42： 1304- 1309.
［15］ 陈雨意，陈艳红，张勇华，等． 新型口服抗凝药物用于经皮左心耳封堵术术中、术后抗凝的初步临床随访结果［J］． 中国介入心脏病学杂志， 2018， 26：547- 552．
［16］ 陈莎莎，潘文志，金沁纯，等． 经皮左心耳封堵术术后早期抗血栓的单中心经验［J］． 中国介入心脏病学杂志， 2019， 27：428- 432．
［17］ Boersma LV， Ince H， Kische S， et al. Efficacy and safety of left atrial appendage closure with WATCHMAN in patients with or without contraindication to oral anticoagulation： 1- year follow- up outcome data of the EWOLUTION trial［J］. Heart Rhythm， 2017， 14： 1302- 1308.
［18］ Merella P， Casu G， Mazzone P， et al. Atrial fibrillation in severe and end stage renal disease： from oral anticoagulation therapy to percutaneous left atrial appendage occlusion［J］. G Ital Nefrol， 2019， 36： 2019- vol1.
［19］ Schirmer SH， Brandenburg V， Antlanger M. Anticoagulation and anti platelet therapy in patients with chronic kidney disease［J］.Dtsch Med Wochenschr， 2019， 144：1423- 1427.

相似文献/References:

[1]顾佳宁,姜伟峰,周 立,等.瑞舒伐他汀对持续性心房颤动导管消融术后早期复发的影响[J].介入放射学杂志,2014,(10):848.
　GU Jia ning,JIANG Wei feng,ZHOU Li,et al.Evaluation of rosuvastatin in preventing early recurrence of persistent atrial fibrillation after catheter ablation treatment[J].journal interventional radiology,2014,(12):848.
[2]王子荣,杨 栋,徐 曌,等.左心耳封堵术MSCT三维成像测量可行性分析和临床应用[J].介入放射学杂志,2016,(12):1035.
　WANG Zi- rong,YANG Dong,XU Zhao,et al.MSCT three- dimensional imaging measurement for percutaneous transcatheter left atrial appendage occlusion： feasibility analysis and clinical application[J].journal interventional radiology,2016,(12):1035.
[3]汤学超,王飞宇,张志钢,等.LACBES左心耳封堵器及动物实验可行性研究[J].介入放射学杂志,2017,(01):44.
　TANG Xue- chao,WANG Fei- yu,ZHANG Zhi- gang,et al.Feasibility study of the use of left atrial appendage occluder LACBES with animal experiment[J].journal interventional radiology,2017,(12):44.
[4]袁 伟,仲建军,李卫东,等.急症经皮冠状动脉血栓抽吸介入治疗心房颤动血栓致急性ST段抬高型心肌梗死11例[J].介入放射学杂志,2019,28(09):870.
　YUAN Wei,ZHONG Jianjun,LI Weidong,et al.Emergency percutaneous coronary interventional thrombus aspiration for acute ST- segment elevation myocardial infarction induced by atrial fibrillation thrombus： clinical effect in 11 patients[J].journal interventional radiology,2019,28(12):870.
[5]吴美桦,郜俊清.肺静脉隔离术联合肾动脉去交感神经术临床治疗心房颤动meta分析[J].介入放射学杂志,2021,30(01):9.
　WU Meihua,GAO Junqing..Pulmonary vein isolation combined with renal artery denervation for the treatment of atrial fibrillation： a meta analysis[J].journal interventional radiology,2021,30(12):9.
[6]张小刚,武英彪,罗 俊,等.Laager与Watchman左心耳封堵器临床疗效对比[J].介入放射学杂志,2021,30(03):230.
　ZHANG Xiaogang,WU Yingbiao,LUO Jun,et al.Laager occluder versus Watchman occluder for left atrial appendage closure： comparison of the clinical efficacy[J].journal interventional radiology,2021,30(12):230.
[7]智 宏,孟敬军,靳 浩,等.睡眠质量对心房颤动患者导管消融术后复发的影响[J].介入放射学杂志,2021,30(07):647.
　ZHI Hong,MENG Jingjun,JIN Hao,et al.The influence of sleep quality on the recurrence of atrial fibrillation after catheter ablation[J].journal interventional radiology,2021,30(12):647.
[8]王远龙,刘 飞,沈成兴.经单侧右股静脉射频消融治疗心房颤动可行性研究[J].介入放射学杂志,2021,30(10):985.
　WANG Yuanlong,LIU Fei,SHEN Chengxing..Radiofrequency ablation purely-via right femoral vein approach for the treatment of atrial fibrillation： study of its feasibility[J].journal interventional radiology,2021,30(12):985.
[9]赵志宏,王赛华,罗 俊,等.心房颤动患者左心耳LAmbre封堵术后器械相关血栓发生及转归分析[J].介入放射学杂志,2022,31(02):130.
　ZHAO Zhihong,WANG Saihua,LUO Jun,et al.Device-related thrombosis after LAmbre left atrial appendage occlusion in patients with atrial fibrillation： analysis of its occurrence and outcomes[J].journal interventional radiology,2022,31(12):130.
[10]王赛华,赵志宏,宋 湘,等.LAmbre封堵器封堵左心耳后密封盘周围漏与封堵器相关血栓发生的关系[J].介入放射学杂志,2022,31(05):442.
　WANG Saihua,ZHAO Zhihong,SONG Xiang,et al.The correlation between peridevice leak and device-related thrombus after left atrial appendage closure with LAmbre occluder[J].journal interventional radiology,2022,31(12):442.
[11]柳芳美,王 健,邓 敏,等.房间隔缺损封堵术后成功植入LAmbre左心耳封堵器1例[J].介入放射学杂志,2022,31(03):252.
　LIU Fangmei,WANG Jian,DENG Min,et al.Successful implantation of LAmbre device in a patient having received atrial septal defect closure[J].journal interventional radiology,2022,31(12):252.
[12]王赛华,郇 强,郝舒文,等.盘式封堵器封堵老年心房颤动患者大口径左心耳的安全性和有效性[J].介入放射学杂志,2022,31(10):958.
　WANG Saihua,HUAN Qiang,HAO Shuwen,et al.The safety and effectiveness of disc-type occluder in occluding large-diameter left atrial appendage in elderly patients with atrial fibrillation[J].journal interventional radiology,2022,31(12):958.
[13]张小刚,武英彪,丛新鹏,等.LACbes左心耳封堵器植入术后固定盘呈高柱状形态的安全性和有效性 [J].介入放射学杂志,2022,31(11):1056.
　ZHANG Xiaogang,WU Yingbiao,CONG Xingpeng,et al.The safety and effectiveness of the fixation disc being squeezed into a high-column shape after LACbes left atrial appendage occluder implantation[J].journal interventional radiology,2022,31(12):1056.

备注/Memo

备注/Memo:
（收稿日期：2020- 03- 22）
（本文编辑：边 佶）
更新日期/Last Update: 2020-12-16