[1]刘善萍 何贵新 甲子永 冯雨菲 韦 娟 詹玲君.非瓣膜性房颤抗凝治疗研究进展[J].大众科技,2023,25(3):162-166.
 Research Progress of Anticoagulation Therapy for Nonvalvular Atrial Fibrillation[J].Popular Science & Technology,2023,25(3):162-166.
点击复制

非瓣膜性房颤抗凝治疗研究进展()
分享到:

《大众科技》[ISSN:1008-1151/CN:45-1235/N]

卷:
25
期数:
2023年3
页码:
162-166
栏目:
医药与卫生
出版日期:
2023-03-20

文章信息/Info

Title:
Research Progress of Anticoagulation Therapy for Nonvalvular Atrial Fibrillation
作者:
刘善萍1 何贵新2 甲子永1 冯雨菲1 韦 娟1 詹玲君1 
(1.广西中医药大学,广西 南宁 530001;2.广西中医药大学第一附属医院,广西 南宁 530023)
关键词:
非瓣膜性房颤口服抗凝药左心耳封堵术房颤导管消融
Keywords:
nonvalvular atrial fibrillation oral anticoagulant left atrial appendage occlusion catheter ablation of atrial fibrillation
文献标志码:
A
摘要:
非瓣膜性房颤患者卒中及全身性栓塞疾病发病率持续增高,抗凝治疗成为防治该病最主要的环节,对卒中及全身性栓塞的防治更是成为近年来国内外研究的热点。在传统抗凝治疗方案中,华法林一直被视为心源性卒中抗凝的二级用药,而阿司匹林则预防合并有冠心病的非瓣膜性患者发生不明原因卒中上疗效显著。随着抗凝药物的发展,新型口服抗凝药实力性地成为首要选择;左心耳封堵术改变了长期口服抗凝药物的现状并解除了来自左心耳的血栓风险;导管消融手术联合抗凝药物的治疗措施不仅能控制房颤症状,还能防治血栓并发症。
Abstract:
The incidence rate of stroke and systemic embolism in patients with nonvalvular atrial fibrillation continues to increase. Anticoagulant therapy has become the most important link in the prevention and treatment of this disease, and the prevention and treatment of stroke and systemic embolism has become a hot research topic at home and abroad in recent years. In the traditional anticoagulation treatment scheme, warfarin has been regarded as the secondary anticoagulation drug for cardiogenic stroke, while aspirin has a significant effect in preventing nonvalvular patients with coronary heart disease from having unexplained stroke. With the development of anticoagulants, the strength of new oral anticoagulants has become the first choice; left atrial appendage occlusion has changed the status quo of long-term oral anticoagulants and relieved the risk of thrombus from left atrial appendage; the treatment of catheter ablation combined with anticoagulant drugs can not only control the symptoms of atrial fibrillation, but also prevent and treat thrombotic complications.

参考文献/References:

[1] 谭琛. 《2020 ECS/EACTS心房颤动诊断和管理指南》解读[J]. 中国循证心血管医学杂志,2021,13(2): 129-132.[2] 张晓晴,李树仁,牛绍乾,等. 非维生素K口服抗凝药在瓣膜性心房颤动中的应用研究进展[J]. 实用心脑肺血管病杂志,2020,28(7): 11-15.[3] 胡利,冉斌,刘丽. 非瓣膜性房颤抗凝治疗的研究进展[J]. 现代医学与健康研究(电子版),2020,4(22): 107-109.[4] 程卓. CHA2DS2-VASc 评分对非房颤慢性心力衰竭的近期预后价值[J]. 实用中西医结合临床,2019,19(3): 118-120.[5] 怀娜. 非瓣膜性房颤患者应用抗凝药物治疗的进展研究[J]. 保健文汇,2021,22(9): 145-146.[6] 叶贞发,叶齐饶,赖心味. 不同强度华法林抗凝对老年非瓣膜性房颤患者长期疗效及预后的影响[J]. 实用临床医药杂志,2019,23(9): 55-58.[7] KHATTAK F, ALAM M B, PAUL T K, et al. Antithrombotic therapy in nonvalvular atrial fibrillation: consensus and challenges[J]. American Journal of the Medical Sciences, 2018, 355(5): 467-476.[8] JOHN R M, SHARMA D. Contraindication to anticoagulation in nonvalvular atrial fibrillation: Are we still to fear the clot and not the bleed[J]. JACC Clinical Electrophysiology, 2019, 5(12): 1393-1395. [9] 邹锦秀,孔令恩,蔡春生. 比较低强度华法林与阿司匹林预防老年非瓣膜性房颤并发脑栓塞的效果[J]. 实用临床医学,2020,21(1): 11-12.[10] 王海艳,朱正炎. 老年非瓣膜病心房颤动患者抗栓治疗分析[J]. 河北医药,2018,40(21): 3261-3264.[11] 陈玲玲. 新型口服抗凝药在静脉血栓栓塞症的应用进展[J]. 按摩与康复医学,2021,12(4): 94-96.[12] BAHRMANN P, CHRIST M. Anticoagulation in geriatric patients with atrial fibrillation: With what and for whom no more[J]. Herz, 2018, 43(3): 214-221.[13] 黄静萍,马娟,李勇国. 达比加群酯与华法林治疗非瓣 膜性心房颤动患者的效果比较[J]. 临床合理用药杂志,2020,13(20): 42-43.[14] 李文英. 直接比较新型口服抗凝药治疗心房颤动疗效和安全性的Meta分析[D]. 福州: 福建医科大学,2019.[15] 张广求,张美祥,王树平. 新型口服抗凝药物适应证及指南推荐意见[J]. 实用心脑肺血管病杂志,2018,26(9): 1-5.[16] 蒋超,郭雪原,马长生. 新型口服抗凝药物在心房颤动合并瓣膜疾病患者中的应用[J]. 内科理论与实践,2017,12(1): 76-78.[17] 侯晓林,曾庆华,陈旸,等. 利伐沙班与华法林用于房颤导管消融术后疗效及安全性的系统分析[J]. 中国临床药理学杂志,2019,35(1): 85-88.[18] 陈敬强. 利伐沙班,华法林防治房颤患者脑卒中的效果对比[J]. 药品评价,2019,16(17): 17-18.[19] VAN GANSE E, DANCHIN N, MAHE I, et al. Comparative safety and effectiveness of oral anticoagulants in nonvalvular atrial fibrillation: The NAXOS study[J]. Stroke, 2020, 51(7): 2066-2075. [20] 长宇,吴思凡,韩佳,等. 基于4种新型口服抗凝药预防非瓣膜性房颤患者脑卒中疗效的网状META分析[J]. 徐州医科大学学报,2020,40(3): 67-72.[21] 张嘉成,黄丽红,蒋志伟,等. 口服抗凝药在心房颤动患者预防脑卒中的效益风险评估[J]. 中国卫生统计,2016,33(4): 612-615.[22] LEE S R, CHOI E K, KWON S, et al. Effectiveness and safety of contemporary oral anticoagulants among asians with nonvalvular atrial fibrillation[J]. Stroke, 2019, 50(8): 2245-2249.[23] WU L, LIANG E, FAN S, et al. Relation of left atrial appendage morphology determined by computed tomography to prior stroke or to increased risk of stroke in patients with atrial fibrillation[J]. American Journal of Cardiology, 2019, 123(8): 1283-1286.[24] NAIROOZ R, SARDAR P, PAYNE J, et al. Meta-analysis of major bleeding with uninterrupted warfarin compared to interrupted warfarin and heparin bridging in ablation of atrial fibrillation[J]. International Journal of Cardiology, 2015, 187(2): 426-429.[25] LIP G Y, DAGRES N, PROCLEMER A, et al. Left atrial appendage occlusion for stroke prevention in atrial fibrillation in Europe: results of the European Heart Rhythm Association survey[J]. Europace, 2013, 15: 141-143.[26] CALKINS H, HINDRICKS G, CAPPATO R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation[J]. Heart Rhythm, 2017, 14(10): e275-e444. [27] 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(10): 547-552.[28] GLIKSON M, WOLFF R, HINDRICKS G, et al. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion an update[J]. EuroIntervention, 2020, 15(13): 1133-1180.[29] ALSAGHEIR A, KOZIARZ A, BELLEY-COTE E P, et al. Left atrial appendage occlusion: A narrative review[J]. Journal of Cardiothoracic and Vascular Anesthesia, 2019, 33(6): 1753-1765.[30] SHARI Z I, HEIST E K. Optimizing durability in radiofrequency ablation of atrial fibrillation[J]. Journal of Innovations in Cardiac Rhythm Management, 2021, 12(5): 4507-4518.[31] ANDRADE J G. Cryoballoon ablation for pulmonary vein isolation[J]. Journal of Cardiovascular Electrophysiology, 2020, 31(8): 2128-2135. [32] XING Y, XU B, XU C, et al. Efficacy and safety of uninterrupted low-intensity warfarin for radiofrequency catheter ablation of atrial fibrillation in the elderly[J]. Annals of Pharmacotherapy, 2017, 51(9): 735-742.[33] ROMERO J, CERRUD-RODRIGUEZ R C, DIAZ J C, et al. 1007-direct oral anticoagulants vs. uninterrupted vitamin Kantagonists during catheter ablation of non-valvular atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials[J]. Europace, 2018, 20(10): 1612-1620. [34] NOGAMI A, HARADA T, SEKIGUCHI Y, et al. Safety and efficacy of minimally interrupted dabigatran vs uninterrupted warfarin therapy in adults undergoing atrial fibrillation catheter ablation[J]. JAMA Network Open, 2019, 2(4): e191994. [35] 中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会. 经冷冻球囊导管消融心房颤动中国专家共识解读[J]. 中华心律失常学杂志,2020, 24(3): 259-264.[35] CALKINS H, WILLEMS S, VERMA A, et al. Heparin dosing in uninterrupted anticoagulation with dabigatran vs. warfarin in atrial fibrillation ablation: RE-CIRCUIT study[J]. Europace, 2019, 21(6): 879-885. [37] CHOI J L, PARK S M, PARK J S, et al. Changes in left atrial structure and function after catheter ablation and electrical cardioversion for atrial fibrillation[J]. Circulation Journal, 2008, 72(12): 2051-2057. [38] HE B, JIANG L S, HAO Z B Y, et al. Combination of ablation and left atrial appendage closure as "one-stop" procedure in the treatment of atrial fibrillation: Current status and future perspective[J]. Pacing and Clinical Electrophysiology, 2021, 44(7): 1259-1266.[39] WINTGENS L I S, KLAVER M N, SWAANS M J, et al. Left atrial catheter ablation in patients with previously implanted left atrial appendage closure evices[J]. Europace, 2019, 21: 428-433.[40] 杨璐,高连君,尹晓盟,等. 不同抗凝方案对心房颤动射频 消融术中肝素用量影响的临床研究[J]. 中华心血管病杂志,2019,47(8): 602-607.[41] 王菲菲,李耀东. 房颤射频消融联合左心耳封堵一站式手术术后抗凝治疗评价[J]. 中国保健营养,2021,31(2): 26.[42] 唐薇,陆世杰,郑铁,等. 单中心非瓣膜性心房颤动患者抗凝治疗现状分析[J]. 中国医药,2021,16(1): 15-18.[43] 郭爽,张强,田志浩,等. 三七总皂苷联用阿司匹林对后者抗血小板凝集作用的影响[J]. 中国实验方剂学杂,2018,24(9): 116-120.[44] 赖艳妮,严一文,徐培平. 基于系统药理学探索莪术有效成分的 药理作用机制[J]. 中国实验方剂学,2017,23(14): 240-245.[45] SONG C G, BI L J, ZHAO J J, et al. The efficacy and safety of hirudin plus aspirin versus Warfarin in the secondary prevention of cardioembolic stroke due to nonvalvular atrial fibrillation: A multicenter prospective cohort study[J]. International Journal of Medical Sciences, 2021, 18(5): 1167-1178.[46] 张明哲,姚允泰,李立环. 心脏手术患者肝素诱导血小板减少症[J]. 中国体外循环杂志,2018,16(5): 293-296,311.

备注/Memo

备注/Memo:
【收稿日期】2022-09-22【作者简介】刘善萍(1997-),女,广西中医药大学在读硕士研究生,研究方向为心血管内科疾病防治。
更新日期/Last Update: 2023-05-31