Observation Of New Oral Anticoagulant Anticoagulation Therapy In Non-valvular Atrial Fibrillation Patients After Radiofrequency Catheter Ablation

Objective:To evaluate the effectiveness of two new oral anticoagulants(Rivaroxaban and Dabigatran Etexilatete)and Warfarin as perioperative anticoagulation therapies in non-valvular atrial fibrillation patients after radiofrequency catheter ablation.Methods:This is a retrospective study 246 patients with non-valvular persistent or paroxysmal atrial fibrillation in our center during June,2014 to May,2015 were chosen as objects of study.They had undergone Catheter Radio frequency ablation,and were observed for their anticoagulation therapies.124 patients were paired into two groups,where one group were given Rivaroxaban 15mg,qd,po?One group were given 3-5mg Warfarin per day.INR(international normalized ratio)was kept within the range of 2.0-3.0.Meanwhile,another 122 patients were paired into two groups,where one group were given Dabigatran Etexilatete 110mg,bid,po?one group were given 3-5mg Warfarin per day.All patients were asked to take the same medicine during their three-month anticoagulation period after operation.Stroke or systemic embolism is chosen as the efficacy endpoint for anticoagulation therapy,and major bleeding,recurrence rate of atrial fibrillation and complications are chosen as the safety endpoint.Results:1 Baseline Comparison:Baseline features of all groups are as follows:age,BMI(body mass index),types of atrial fibrillation(paroxysmal and persistent),CHA2DS2-VASc rating,HAS-BLED rating,preoperative evaluations(HB,ALT,CCR,PT,APTT,TT),past complications(congestive heart failure,high blood pressure,diabetes,thyroid dysfunction,COPD,stroke/systemic embolism/TIA),preoperative LAD,EF percentage,preoperative medication(Cordarone,aspirin,warfain,ACEI,13-receptor blocker).Patients with preoperative use of warfarin compared the two groups have significant difference?The other differences were not statistically significant(p-value>0.05).2.Comparisons on anticoagulation efficacy and safety endpoint based on three-month follow-up after ablation(1)No death was reported in Rivaroxaban group and its Warfarin control group.There were no embolization events(stroke,TIA and systemic embolism)in the Rivaroxaban group,while in its Warfarin control group,there was one case of TIA and no stroke,nor systemic embolism.Difference regarding stroke did not reach statistical significance(p-value>0.05).Neither group experienced severe bleeding.Rivaroxaban group saw three cases of gingival bleeding,six cases of hematuria,two cases of subcutaneous bleeding,three cases of groin hematoma,and no sputum with blood.In its Warfarin control,there was one case of gingival bleeding,three cases of sputum with blood,six cases of hematuria and three cases of groin hematoma,The bleeding symptoms disappeared after the patient stopped taking medicine.Difference regarding minor bleeding is not statistically significant(p-value>0.05).(2)There were no deaths in Dabigatran Etexilatete group and its Warfarin control group.Dabigatran Etexilatete group witnessed two cases of TIA and no stoke nor systemic embolism,while in the warfarin group,there was no TIA,stroke nor systemic embolism.The difference regarding stroke is not statistically significant(p-value>0.05).There was no severe bleeding in either group.Dabigatran Etexilatete group experienced one case of gingival bleeding,eight cases of hematuria,three cases of subcutaneous bleeding,four cases of groin and hematoma,no sputum with blood.In its Warfarin control,there were four cases of gingival bleeding,three cases of sputum with blood,four cases of hematuria and two cases of groin hematoma.The bleeding symptoms disappeared after the patient stopped taking medicine.The difference regarding minor bleeding is not statistically significant(p-value>0.05).3.Comparison in recurrence of atrial fibrillation and complications(1)Rivaroxaban group and its Warfarin control groupRivaroxaban group saw ten cases of recurrence of atrial fibrillation,five cases of electric cardioversion,ten cases of fever and.Its Warfarin control group experienced thirteen cases of recurrence of atrial fibrillation,five cases of electric cardioversion,one case of esophageal submucosal bleeding,four cases of fever.Complications had all been cured by the time of hospital discharge.Differences regarding recurrence of atrial fibrillation and complications were not statistically significant(p-value>0.05),nor did that in patient's compliance.(2)Dabigatran Etexilatete group and its Warfarin control group both had six cases of electric cardioversion.Dabigatran Etexilatete group witnessed twenty cases of recurrence of atrial fibrillation,nine cases of fever.Its Warfarin control experienced sixteen cases of recurrence of atrial fibrillation,four cases of fever and.The complications had all been cured by the time of hospital discharge.Differences regarding recurrence of atrial fibrillation and complications were not statistically significant(p-value>0.05),nor did that in patient's compliance.Conclusion:Oral Rivaroxaban and Dabigatran Etexilatete are effective forperioperative anticoagulation therapy in non-valvular atrial fibrillation patients after radiofrequency catheter ablation,with little risk of stroke and bleeding.They are comparable to warfarin and require no detection of coagulation indices.