新型口服抗凝剂在心房颤动合并脑微出血患者应用的安全性

摘要

目的 探讨新型口服抗凝剂(NOACs)达比加群酯在非瓣膜性心房颤动合并脑微出血患者(CMB)应用的安全性.方法 心房颤动患者205例分为CMB组87例和无CMB组118例,CHA2DS2-VASc评分≥2患者进行达比加群酯抗凝治疗,CHA2DS2-VASc评分1分根据获益与风险衡量,行达比加群酯抗凝或阿司匹林抗栓治疗,所有患者行1年随访,症状性出血(ICH)为终点事件,头颅CT以证实.结果 CMB组较无CMB组患者达比加群酯抗凝治疗后出血转化发生率差异无统计学意义.但按数量进一步分层分析后,当微出血的数量≥10个时,其出血转化明显高于对照组.结论 当CMB<7,达比加群酯抗凝治疗可能是安全的.%Objective To investigate the safety of a new oral anticoagulant(NOACs)in patients with non-valvular atrial fibrillation and cerebral microhemorrhage(CMB). Methods 205 patients with atrial fibrillation were divided into CMB group(87 cases)and non-CMB group(118 cases). Patients with CHA2DS2-VASc score(≥2)were treated with anticoagulation with Pradaxar,and patients with CHA2DS2-VASc score 1 were treated with anticoagulation with Pradaxa or aspirin according to the benefit and risk. All patients were followed up for one year. Symptomatic hemorrhage(ICH) was the endpoint event,which was confirmed by cranial CT. Results There was no significant difference in hemorrhagic transformation between CMB group and non-CMB group after anticoagulation therapy. However,when the number of microbleeding was more than 10,the hemorrhagic transformation was significantly higher than that of the control group. Conclusion When CMB<10,anticoagulant therapy with NOACs may be safe.