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ACC2017:RE-CIRCUIT研究:房颤患者导管消融围手术期不间断使用泰毕全较华法林大出血显著减少

2017-03-21 佚名 中国循环杂志

在2017年ACC年会上公布的RE-CIRCUIT研究让人眼前一亮,该研究结果表明,房颤患者在导管消融围手术期间不间断使用泰毕全(达比加群酯)更为安全,大出血和严重不良反应事件均显着减少[1]。这一研究结果同时也在《新英格兰杂志》刊登[2]。



在2017年ACC年会上公布的RE-CIRCUIT研究让人眼前一亮,该研究结果表明,房颤患者在导管消融围手术期间不间断使用泰毕全(达比加群酯)更为安全,大出血和严重不良反应事件均显着减少[1]。这一研究结果同时也在《新英格兰杂志》刊登[2]。

研究显示,使用泰毕全的房颤患者在消融术中和术后2个月内,大出血发生率的绝对风险降低了5.3%。

具体在泰毕全组的患者大出血比例显着降低(1.6% vs 6.9%),相对风险降低了77.2%;此外两组轻微出血比例相似(18.6% vs 16.9%);在血栓栓塞方面,泰毕全组无血栓栓塞病例,华法林组有1例患者出现栓塞。

RE-CIRCUIT研究指导委员会主席、美国巴尔的摩约翰霍普金斯医院电生理学实验室和心律失常科主任Hugh Calkins教授表示:“在消融术过程中,房颤患者面临发生卒中和出血等的潜在风险,因此抗凝管理在房颤消融术过程中至关重要。而RE-CIRCUIT研究结果带来了好消息。”

“这再次证明了泰毕全较华法林对患者更安全,”勃林格殷格翰血管治疗领域副总裁Jorg Kreuzer教授说,“泰毕全是目前唯一一种当患者在消融术过程出现并发症时,可根据需要使用逆转剂idarucizumab(Praxbind)立即停止抗凝作用的新型口服抗凝药。虽然临床或一般不需要使用逆转剂,但有逆转剂可用总归更为安全。”

这项随机对照多中心研究共纳入104个医疗中心635例行导管消融术的阵发性或持续性非瓣膜性房颤患者。其中317例患者不间断使用泰毕全(150mg,2次/日),另外318例患者不间断使用华法林。研究者在其3~4个月的治疗中评估两种策略的安全性和有效性,治疗结束后随访1周。其中主要终点大出血发生率根据国际血栓栓塞与止血学会(ISTH)所定义。

原始出处:
[2]Calkins H, Willems S, Gerstenfeld EP, et al. Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation. N Engl J Med, March 19, 2017

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    2017-03-23 cmsvly
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来自法国的戴维(Jean-Marc Davy)教授在本次ESC年会上作了“在全科医学实践中识别新发房颤的简单认识运动”(PROFIL FA研究)的报告。戴维教授说:“房颤是最常见的心律失常。房颤使心衰风险升高3倍、卒中风险升高5倍;1/4的缺血性卒中患者病因是房颤。但是,房颤经常被忽略,确诊较晚。20%的病例是由于发生了卒中后才确诊有房颤。为此,我们发起了一项运动以改进房颤的早期诊断。”

Heart:房颤患者cTnI 和NT-proBNP持续升高提示预后不良

RE-LY试验亚组分析显示,在房颤患者中,与肌钙蛋白I(cTnI)和N末端脑钠肽前体(NT-proBNP)水平短暂升高或不升高相比,这两种标志物水平持续升高提示患者预后较差。重复测定这些心脏标志物水平可改善卒中、死亡和心血管事件的预后。论文5月2日在线发表于《心脏》(heart)杂志。 研究纳入RE-LY试验的2514例心房颤动患者,随机分组和3个月后采血样测定cTnI和NT-proBNP水平,

JACC:强化抗栓不改善房颤患者预后?

美国一项研究表明,在同时伴有心衰和血管疾病的房颤患者中,于维生素K拮抗剂(VKA)治疗基础上添加抗血小板药物未能降低血栓栓塞或冠脉风险,反而会升高出血风险。论文于4月30日在线发表于《美国心脏病学会杂志》(J Am Coll Cardiol)。此项研究共纳入37464例伴有冠脉疾病或外周动脉疾病等血管疾病的心衰住院患者,平均年龄为74.5岁,女性36.3%。将房颤状况分类为泛发、偶发和无房颤。以抗

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