[ACC2011]房颤消融后的抗凝治疗——Kenneth A. Ellenbogen教授专访
许多危险因素可以导致房颤发展。对许多患者来说,射频消融术可以在很长一段时间内控制这种心律失常,但随着时间的推移,房颤可能再次发生,这就是为什么要处理这些危险因素的原因。
International Circulation: It is controversial whether and for how long anticoagulation should be used after atrial fibrillation ablation. Could you tell us our views on that?
《国际循环》:对于房颤射频消融术后是否需要抗凝及其抗凝时间存在争议,请问您如何看待此问题?
Dr. Ellenbogen: Our view is that patients who are at low risk of AF probably don’t need anything more than aspirin. Patients who are at high risk probably need to be on Coumadin or dabigatran and definitely I think we are going to use those two agents interchangeably. For patients who are intermediate risk, there are two lines of thought. One is: treat them for their risk factors. If they have intermediate risk for stroke you might want aspirin or you might want an oral anticoagulant like dabigatran or warfarin. On the other hand, there are some who believe that if you get a great response from catheter ablation and arrhythmia suppression, you can monitor that patient closely and it may be ok to stop their oral anticoagulant.
Dr. Ellebogen:我们的观点是,对于低危患者,不需要应用任何药物或仅用阿司匹林;高危患者可能需应用香豆素类或达比加群,而且我非常确定的一点是,需交替使用这两种药物进行抗凝治疗。对于中危患者,有两种思路,一是治疗房颤的危险因素,如果患者同时合并有卒中的危险因素,可能需使用阿司匹林或诸如达比加群或华法林之类的口服抗凝药物。另一方面,如果患者在导管射频消融术中取得良好疗效,房颤成功地被抑制,那么在密切随访的情况下可以停用口服抗凝药物治疗。
International Circulation: Since the RE-LY study, it is suggested that dabigatran is effective and safe and the FDA approved dabigatran to be used to prevent stroke in atrial fibrillation patients. Can you tell us your real life experience with dabigatran especially its safety profile?
《国际循环》:通过RE-LY研究,达比加群被认为是有效的、安全的,同时美国FDA也批准达比加群用于房颤患者的卒中预防。您能和我们分享您对于达比加群的实际应用经验,特别是安全性方面?
Dr. Ellenbogen: It has only been around for a short period of time so I don’t have huge amounts of experience, but our experience so far is excellent. It is safe and it is effective and it will continue to be used in place of Coumadin.
Dr. Ellebogen:因为达比加群的应用时间还比较短,所以没有太多的经验,但就目前我们所得到的结果来看,达比加群是非常出色的,它安全有效,将替代香豆素类药物。