目的 探讨近5年来非瓣膜病心房颤动射频消融围手术期抗凝治疗的应用状况及卫生经济学特点，分析华法林与新型口服抗凝药物（NOACs）的有效性及安全性。

方法 连续性入选2015年1月至2019年8月阜外医院心律失常一病区住院的1936例非瓣膜病房颤患者，对其围手术期抗凝方案、药物构成比例、治疗费用及出血、栓塞事件进行回顾性分析，随访期限为术后3个月。

结果 1936例患者其中男性1406例（72.6%），女性530例（27.4%），平均年龄56.4±10.4岁，房颤病史中位时间为3年，1439例为间断性抗凝，其余497例连续性抗凝治疗；2015年至2019年间华法林占比呈明显下降（2015对比2019：79.8% vs 20.2%，P<0.001）, 利伐沙班及达比加群酯占比呈明显上升（P<0.001）；2015-2017年年化人均药物费用（元/人年）显著上升趋势（2609.9比6096.4比10339.4，P<0.001）；成本效果分析显示华法林较利伐沙班、达比加群酯具有更优的成本效果比（217.8比13158.7比12142.1，P<0.001）。3个月随访期间无死亡事件，共发生大出血9例（0.46%）及栓塞事件17例（0.88%），包括中枢神经系统栓塞15例；华法林与利伐沙班、达比加群酯的栓塞（1.2% vs 0.65% 比 0.76%,P=0.35）及大出血并发症（0.76% 比 0.32% 比 0.3%,P=0.40）无显著差异，连续性及间断抗凝治疗亚组分析中华法林与新型口服抗凝药之间亦无显著差异。

结论 研究结果提示对于非瓣膜性房颤患者的围手术期抗凝治疗中，华法林与NOACs的安全性及有效性相当；成本效果分析显示华法林较NOACs有明显的效价优势。

Abstract

OBJECTIVE   This respective study was intended to analyze the clinical characteristics and health economic data of periprocedural anticoagulation in non-valvular atrial fibrillation（NVAF） patients in the past 5 years.

METHODS   A total of 1936 patients with non-valvular AF from January 2005 to August 2019 in Fuwai hospital were enrolled consecutively, all the patients received transcatheter radiofrequency ablation. We retrospectively analyzed constituent ration and cost of anticoagulation and the incidence of major bleeding and embolization events in the cohort to assess the safety and efficacy of different oral anticoagulants (warfarin, rivaroxaban, dabigatran).

RESULTS    We enrolled 1,406 males (72.6%) and 530 females (27.4%), with an average age of 56.4±10.4 years. From 2015 to 2019, the proportion of warfarin decreased significantly (2015 vs. 2019: 79.8% vs. 20.2%, P<0.001), rivaroxaban (2015 vs. 2019: 8.4% vs. 49.1%, P<0.001), and dabigatran increased significantly (2015 vs. 2019:18.2% vs. 40.7%, P<0.001). The cost-effectiveness analysis showed that Warfarin had a better cost-effectiveness ratio than Rivaroxaban and Dabigatran (217.8 vs. 13158.7 vs. 12142.1, P<0.001).During the 3 month follow-up, no deaths occurred, and there were 9 cases (0.46%) of major hemorrhage and 17 cases (0.88%) of embolization events, including 15 cases of central nervous system embolization. The embolization of warfarin and rivaroxaban and dabigatran (1.2% vs 0.65% vs 0.76%,P=0.35) and the complications of major bleeding (0.76% vs 0.32% vs 0.3%,P=0.40) were not significantly different, and there was no significant difference between the analysis of continuous and intermittent anticoagulation subgroup and the novel oral anticoagulants(NOAC).

CONCLUSIONS   The results suggest that warfarin and NOACs have similar safety and efficacy in perioperative anticoagulation therapy for patients with NVAF. In addition, warfarin is more cost-effective than NOACs from the perspective of health economics.