Blood Coagulation Status during Cryofreezing Ablation and Effects of the Direct Anticoagulants Dabigatran and Edoxaban
Blood Coagulation Status during Cryofreezing Ablation and Effects of the Direct Anticoagulants Dabigatran and Edoxaban
复制标题
DOI：
10.1536/ihj.19-450
复制
发表时间：
2020-03-01
影响因子：
1.5
通讯作者：
Hirao, Kenzo
中科院分区：
文献类型：
--
作者：
Okishige, Kaoru;Hirao, Tatsuhiko;Hirao, Kenzo
冷冻消融是一种公认的以导管为基础的治疗房颤的方法。然而，在冷冻消融过程中，血栓栓子事件是无法避免的。冰冻过程中凝血状态的相关资料较少。对63例房颤患者应用冷冻机时，当冷冻机温度降至最低点时，检测患者血液中凝血酶抗凝血酶复合体(TAT)和凝血酶原片段1+2(F1+2)。冷冻前后猪血中的TAT和F1+2分别从279.6+/-146.4和323.6+/-169.1 pmol/L(P=0.004)升高到9.16+/-7.28 ng/mL(P=0.004)。冻存期TAT由0.46增至0.87 ng/m L(P<；0.05)，静脉注射依多沙班后30分钟恢复至0.39 ng/m L，达比卡坦在冷冻过程中未能发挥足够的抗凝作用。相比之下，静脉注射依多沙班似乎在极端低温环境下激发了抗凝作用。
Cryoballoon ablation is an established catheter-based approach to treat atrial fibrillation (AF). However, thromboembolic events cannot be avoided during cryoablation. There is little data regarding the blood coagulation status during freezing.The thrombin antithrombin complex (TAT) and prothrombin fragment 1+2 (F 1+2) of patient blood were measured during cryoballoon application when the cryoballoon temperature reached the nadir in 63 AF patients. TAT was also measured from porcine blood during cryoballoon freezing in 5 pigs.The TAT and F 1+2 increased from 6.60 +/- 5.65 to 9.16 +/- 7.28 ng/mL (P = 0.004) and from 279.6 +/- 146.4 to 323.6 +/- 169.1 pmol/L (P = 0.003) between the control and during freezing, respectively. The TAT increased from 0.46 to 0.87 ng/mL during freezing compared to that of pre-freezing (P < 0.05), and it returned to 0.39 ng/mL in 30 minutes after an intravenous edoxaban administration (N.S.).Dabigatran failed to exert sufficient anticoagulant effects during cryofreezing. In contrast, intravenous edoxaban seemed to provoke anticoagulation effects under extreme low temperature circumstances.