Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Circ Arrhythm Electrophysiol. 2013 Jun;6(3):460-6. doi: 10.1161/CIRCEP.113.000320. Epub 2013 Apr 3.
Pulmonary vein isolation (PVI) for atrial fibrillation is associated with a transient increased risk of thromboembolic and hemorrhagic events. We hypothesized that dabigatran can be safely used as an alternative to continuous warfarin for the periprocedural anticoagulation in PVI.
A total of 999 consecutive patients undergoing PVI were included; 376 patients were on dabigatran (150 mg), and 623 patients were on warfarin with therapeutic international normalized ratio. [corrected] Dabigatran was held 1 to 2 doses before PVI and restarted at the conclusion of the procedure or as soon as patients were transferred to the nursing floor. Propensity score matching was applied to generate a cohort of 344 patients in each group with balanced baseline data. Total hemorrhagic and thromboembolic complications were similar in both groups, before (3.2% versus 3.9%; P=0.59) and after (3.2% versus 4.1%; P=0.53) matching. Major hemorrhage occurred in 1.1% versus 1.6% (P=0.48) before and 1.2% versus 1.5% (P=0.74) after matching in the dabigatran versus warfarin group, respectively. A single thromboembolic event occurred in each of the dabigatran and warfarin groups. Despite higher doses of intraprocedural heparin, the mean activated clotting time was significantly lower in patients who held dabigatran for 1 or 2 doses than those on warfarin.
Our study found no evidence to suggest a higher risk of thromboembolic or hemorrhagic complications with use of dabigatran for periprocedural anticoagulation in patients undergoing PVI compared with uninterrupted warfarin therapy.
肺静脉隔离（PVI）治疗房颤与血栓栓塞和出血事件的一过性风险增加相关。我们假设达比加群可安全替代华法林，用于 PVI 的围手术期抗凝。
共纳入 999 例连续行 PVI 的患者；376 例患者使用达比加群（150mg），623 例患者使用华法林，国际标准化比值为治疗范围。达比加群在 PVI 前停用 1 至 2 剂，在手术结束时或患者转移至护理病房时重新开始使用。应用倾向评分匹配生成两组各 344 例匹配良好的基线数据。两组围手术期总体出血和血栓栓塞并发症相似，匹配前（3.2%比 3.9%；P=0.59）和匹配后（3.2%比 4.1%；P=0.53）均相似。达比加群组大出血发生率为 1.1%比 1.6%（P=0.48），华法林组分别为 1.2%比 1.5%（P=0.74）。达比加群组和华法林组各发生 1 例血栓栓塞事件。尽管术中肝素剂量较高，但与华法林组相比，停用达比加群 1 或 2 剂的患者平均活化凝血时间显著降低。
我们的研究未发现与华法林不间断治疗相比，在接受 PVI 的患者中使用达比加群进行围手术期抗凝治疗与血栓栓塞或出血并发症风险增加相关的证据。
