From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
Circ Arrhythm Electrophysiol. 2014 Aug;7(4):576-82. doi: 10.1161/CIRCEP.114.001586. Epub 2014 Jun 26.
This study aimed to evaluate the safety of continuous periprocedural rivaroxaban administration during left atrial radiofrequency ablation (RFA) in comparison with uninterrupted oral vitamin K antagonist administration. Data about the use of rivaroxaban in the setting of left atrial RFA procedures are lacking.
The study cohort included 544 patients (mean age, 63±10 years) who underwent left atrial RFA procedures between February 2012 and May 2013. All patients (n=272) receiving uninterrupted periprocedural rivaroxaban 15 or 20 mg/d before the procedure (rivaroxaban) were matched by age, sex, and type of rhythm disorder with an equal number of patients managed with uninterrupted vitamin K antagonist phenprocoumon (international normalized ratio, 2-3). During RFA, heparin was given intravenously to maintain an activated clotting time at 270 to 300 s. The safety end point was a composite of bleeding, thromboembolic events, and death. There were no thromboembolic complications and no deaths in either group. The prevalence of major bleeding complications was similar in both groups (1 tamponade in RivG and 1 groin hematoma requiring transfusion in phenprocoumon). Minor bleeding complications occurred equally in both groups (20 of 272; 7% in the rivaroxaban versus 33 of 272, 12% in the phenprocoumon; P=0.08). In multivariable analyses, female sex was associated with a greater risk of complications (odds ratio, 1.96; 95% confidence interval, 1.10-3.49).
In patients undergoing left atrial RFA, continuous periprocedural rivaroxaban use seems to be as safe as uninterrupted periprocedural phenprocoumon administration.
本研究旨在评估与持续口服维生素 K 拮抗剂相比，左心房射频消融（RFA）期间连续应用利伐沙班的安全性。目前关于左心房 RFA 中应用利伐沙班的数据较为缺乏。
该研究纳入了 544 例于 2012 年 2 月至 2013 年 5 月间行左心房 RFA 的患者（平均年龄 63±10 岁）。所有接受术前持续应用利伐沙班 15 或 20 mg/d（利伐沙班组）的患者（n=272）均按年龄、性别和节律障碍类型与等数量接受持续口服维生素 K 拮抗剂苯丙香豆素（国际标准化比值 2-3）治疗的患者进行匹配。RFA 期间，静脉内给予肝素以维持激活凝血时间在 270-300 s。安全性终点为出血、血栓栓塞事件和死亡的复合终点。两组均未发生血栓栓塞并发症和死亡。两组大出血并发症的发生率相似（利伐沙班组 1 例填塞、苯丙香豆素组 1 例腹股沟血肿需输血）。两组均发生了同样比例的轻微出血并发症（利伐沙班组 20 例[7%] vs. 苯丙香豆素组 33 例[12%]；P=0.08）。多变量分析显示，女性与并发症风险增加相关（比值比 1.96；95%置信区间 1.10-3.49）。
在接受左心房 RFA 的患者中，连续应用利伐沙班似乎与持续应用维生素 K 拮抗剂同样安全。
