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首页> 外文期刊>Journal of Clinical Medicine >Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation
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Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation

机译：与维生素K拮抗剂相比，不间断的Dabigatran施用提供了更大的抑制性止血剂的脑膜炎，与心房颤动的卤化剂导管消融的维生素K拮抗剂相比

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Background. Cerebral thromboembolism is a rare but feared complication of transcatheter ablation in patients with atrial fibrillation (AF). Here, we aimed to test which pre-procedural anticoagulation strategy results in less intracardiac activation of hemostasis during ablation. Patients and methods. In this observational study, 54 paroxysmal/persistent AF patients undergoing cryoballoon ablation were grouped according to their periprocedural anticoagulation strategy: no anticoagulation (oral anticoagulation (OAC) free; n = 24), uninterrupted vitamin K antagonists (VKA) ( n = 11), uninterrupted dabigatran ( n = 17). Blood was drawn from the left atrium before and immediately after the ablation procedure. Cryoablations were performed according to standard protocols, during which heparin was administered. Heparin-insensitive markers of hemostasis and endothelial damage were tested from intracardiac samples: D-dimer, quantitative fibrin monomer (FM), plasmin-antiplasmin complex (PAP), von Willebrand factor (VWF) antigen, chromogenic factor VIII (FVIII) activity. Results. D-dimer increased significantly in all groups post-ablation, with lowest levels in the dabigatran group (median [interquartile range]: 0.27 [0.36] vs. 1.09 [1.30] and 0.74 [0.26] mg/L in OAC free and uninterrupted VKA groups, respectively, p 0.001). PAP levels were parallel to this observation. Post-ablation FM levels were elevated in OAC free (26.34 [30.04] mg/L) and VKA groups (10.12 [16.01] mg/L), but remained below cut-off in all patients on dabigatran (3.98 [2.0] mg/L; p 0.001). VWF antigen and FVIII activity increased similarly post-ablation in all groups, suggesting comparable procedure-related endothelial damage. Conclusion. Dabigatran provides greater inhibition against intracardiac activation of hemostasis as compared to VKAs during cryoballoon catheter ablation.
机译：背景。脑血栓栓塞是一种罕见的，但令人担心的心房颤动患者经截面消融的复杂性（AF）。在这里，我们旨在测试哪种前抗凝策略导致在消融期间止血的较少的心内激活。患者和方法。在这个观察性研究中，54例致癌杀灭杀菌的阵发性/持久性AF患者根据其霸王抗凝血策略进行分组：没有抗凝血（口服抗凝（OAC）自由; n = 24），不间断的维生素K拮抗剂（VKA）（n = 11） ，不间断的dabigatran（n = 17）。在消融程序之后，从左心房中抽出血液。根据标准方案进行冷冻剂，在此期间施用肝素。从肠腔样品测试止血和内皮损伤的肝素不敏感标记：D-二聚体，定量纤维蛋白单体（FM），纤溶酶 - 抗蛋白复合物（PAP），von Willebrand因子（VWF）抗原，发色因子VIII（FVIII）活性。结果。 D-DIMER在烧蚀后的所有组中显着增加，Dabigatran组中的最低水平（中位数[四分位数范围]：0.27 [0.36]和0.74 [0.26] Mg / L在OAC自由和不间断的VKa中分别分别p <0.001）。 PAP水平与此观察结果平行。烧蚀后的FM水平在无量的OAC中升高（26.34 [30.04mg / L）和VKA基团（10.12 [16.01 mg / L），但在Dabigatran的所有患者中仍然低于截止（3.98 [2.0] mg / l; p <0.001）。 VWF抗原和FVIII活性在所有群体中相似地增加了烧蚀后，表明可比程序相关的内皮损伤。结论。与龙骨导管消融期间的VKA相比，Dabigatran对止血炎的血液溶液激活的更大抑制。

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