Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
J Am Coll Cardiol. 2014 Mar 18;63(10):982-8. doi: 10.1016/j.jacc.2013.11.039. Epub 2014 Jan 8.
The purpose of this study was to evaluate the feasibility and safety of uninterrupted rivaroxaban therapy during atrial fibrillation (AF) ablation.
Optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during and after AF ablation. The safety and efficacy of uninterrupted rivaroxaban therapy as a periprocedural anticoagulant for AF ablation are unknown.
We performed a multicenter, observational, prospective study of a registry of patients undergoing AF ablation in 8 centers in North America. Patients taking uninterrupted periprocedural rivaroxaban were matched by age, sex, and type of AF with an equal number of patients taking uninterrupted warfarin therapy who were undergoing AF ablation during the same period.
A total of 642 patients were included in the study, with 321 in each group. Mean age was 63 ± 10 years, with 442 (69%) males and 328 (51%) patients with paroxysmal AF equally distributed between the 2 groups. Patients in the warfarin group had a slightly higher mean HAS- BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score (1.70 ± 1.0 vs. 1.47 ± 0.9, respectively; p = 0.032). Bleeding and embolic complications occurred in 47 (7.3%) and 2 (0.3%) patients (both had transient ischemic attacks) respectively. There were no differences in the number of major bleeding complications (5 [1.6%] vs. 7 [1.9%], respectively; p = 0.772), minor bleeding complications (16 [5.0%] vs. 19 [5.9%], respectively; p = 0.602), or embolic complications (1 [0.3%] vs. 1 [0.3%], respectively; p = 1.0) between the rivaroxaban and warfarin groups in the first 30 days.
Uninterrupted rivaroxaban therapy appears to be as safe and efficacious in preventing bleeding and thromboembolic events in patients undergoing AF ablation as uninterrupted warfarin therapy.
本研究旨在评估在心房颤动（AF）消融过程中持续使用利伐沙班治疗的可行性和安全性。
在 AF 消融过程中和之后，为了将出血和血栓栓塞并发症的风险最小化，选择最佳的围手术期抗凝策略至关重要。对于 AF 消融的围手术期抗凝，持续使用利伐沙班治疗的安全性和有效性尚不清楚。
我们进行了一项多中心、观察性、前瞻性研究，纳入了北美 8 个中心接受 AF 消融的患者注册登记。持续使用利伐沙班进行围手术期治疗的患者与同期接受不间断华法林治疗并接受 AF 消融的患者进行年龄、性别和 AF 类型匹配，每组各有 321 例患者。
本研究共纳入 642 例患者，每组 321 例。平均年龄为 63±10 岁，442 例（69%）为男性，328 例（51%）为阵发性 AF，两组患者分布均衡。华法林组的平均 HAS-BLED（高血压、肾功能或肝功能异常、卒中、出血史或倾向、不稳定的国际标准化比值、年龄大、同时使用药物/酒精）评分略高（分别为 1.70±1.0 和 1.47±0.9，p=0.032）。出血和栓塞并发症分别发生在 47 例（7.3%）和 2 例（0.3%）患者（均为短暂性脑缺血发作）。两组大出血并发症的数量无差异（分别为 5 例[1.6%]和 7 例[1.9%]，p=0.772），小出血并发症（分别为 16 例[5.0%]和 19 例[5.9%]，p=0.602）和栓塞并发症（分别为 1 例[0.3%]和 1 例[0.3%]，p=1.0）。
在接受 AF 消融的患者中，持续使用利伐沙班治疗似乎与持续使用华法林治疗一样安全有效，可以预防出血和血栓栓塞事件。
