目的

评估非瓣膜性心房颤动（房颤）患者一站式术后不同抗凝策略的有效性及安全性。

方法

连续纳入分析2018 年4 月至2021 年10 月于新疆医科大学第一附属医院行房颤一站式手术的患者。收集患者年龄、性别等人口学资料，房颤类型、肝肾功能、超声心动图参数、既往合并症、口服抗凝药物等资料。术后根据患者接受不同的抗凝策略，分为联合服用新型口服抗凝药与抗血小板药组（联合组）及单独服用新型口服抗凝药组（抗凝组），定期随访收集患者全因死亡、大出血、任何卒中、血栓栓塞及器械相关血栓（DRT）、封堵器脱落、残余分流＞5 mm 等信息。安全性终点定义为全因死亡及大出血；有效性终点定义为任何卒中、血栓栓塞及DRT；复合终点定义为全因死亡、大出血、卒中、血栓栓塞及DRT。

结果

共纳入126 例患者，其中男占63.5%（80/126），年龄68.5（61.3，76.0）岁，CHA₂DS_2-VASc 评分 4（3，5）分，HAS-BLED 评分2（1，3）分。联合组73 例，抗凝组53 例。随访10（6，16）个月。联合组发生2 例（2.7%，2/73）大出血事件，1 例（1.4%，1/73）下肢深静脉血栓，1 例（1.4%，1/73）死亡，15例（20.5%，15/73）复发。抗凝组发生1例（1.9%，1/53）下肢深静脉血栓，9例（17%，9/53）复发。两组患者均未发生脑卒中、封堵器脱落、DRT、残余分流＞5 mm 等事件。两组患者安全性及有效性终点事件发生率方面差异无统计学意义（P＞0.05）。两组患者复合终点生存分析差异无统计学意义（Log-rank P=0.285）。

结论

房颤患者行一站式手术后，单独服用新型口服抗凝药与联合服用新型口服抗凝药合并抗血小板药同样安全、有效。

Objective

To evaluate the efficacy and safety of different anticoagulation strategies after one-stop surgery in patients with non-valvular atrial fibrillation (AF).

Methods

Patients who underwent one-stop surgery for AF at The first Affiliated Hospital of Xinjiang Medical University from April 2018 to October 2021 were included consecutive. Demographic data such as age and sex, type of AF, liver and renal function, echocardiographic parameters, previous comorbidities and oral anticoagulants of patients were collected. The postoperative period was divided into a group of patients taking novel oral anticoagulants in combination with antiplatelet agents (combined group) and a group taking novel oral anticoagulants alone (anticoagulation group), depending on the different anticoagulation strategies they received. Patients were followed up regularly to collect information on all-cause mortality, major bleeding, any stroke,thromboembolism and device-related thrombosis (DRT), occluder dislodgement and residual shunt ＞5 mm. The safety end point was defined as all-cause death and major bleeding; the effectiveness end point was defined as any stroke, thromboembolism and DRT, and the composite end point was defined as all-cause death, major bleeding, stroke, thromboembolism and DRT.

Results

A total of 126 individuals were included, 63.5% (80/126) were male, with a median age of 68.5 (61.3, 76.0) years, a CHA₂DS₂-VASc score of 4 (3, 5) and a HAS-BLED score of 2 (1, 3). There were 73 patients in the combined group and 53 patients in the anticoagulation group. Median follow-up was 10 (6, 16) months. In the combined group, there were 2 (2.7%, 2/73) major haemorrhagic events, 1 (1.4%, 1/73) lower limb deep vein thrombosis, 1 (1.4%, 1/73) death, and 15(20.5%, 15/73) recurrences. In the anticoagulation group, there were 1 (1.9%, 1/53) lower limb deep vein thrombosis and 9 (17%, 9/53) recurrences occurred. No events such as stroke, blocker dislodgement, DRT, or residual shunt ＞5 mm occurred in either group. There was no statistically significant difference between the two groups in terms of safety and efficacy endpoint events (P＞0.05). The difference in survival analysis of the composite endpoint between the two groups was not statistically significant (Log-rank P = 0.285).

Conclusion

Novel oral anticoagulants alone are as safe and effective as a combination of novel oral anticoagulants combined with antiplatelet agents in patients with AF after one-stop surgery.