Southlake Regional Health Centre, Newmarket, Ontario, Canada.
Southlake Regional Health Centre, Newmarket, Ontario, Canada.
Can J Cardiol. 2014 Dec;30(12):1541-6. doi: 10.1016/j.cjca.2014.09.018. Epub 2014 Sep 28.
There is a paucity of data that compare traditional vitamin K antagonist (VKA) with novel oral anticoagulant regimens in periprocedural management of cardioversion or ablation of atrial fibrillation (AF). We sought to compare outcomes of use of VKA, dabigatran (DABI), and rivaroxaban (RIVA) anticoagulation around the time of intervention.
We studied consecutive patients undergoing cardioversion or ablation of AF at our centre from October 2010 to October 2013. There were 3 different anticoagulation groups: warfarin (VKA), DABI, and RIVA. Safety was assessed according to number of strokes, transient ischemic attacks (TIAs), and clinically important and not important bleeding events.
Baseline characteristics were well balanced between the groups. Average follow-up was 6 months (± 4 months). A total of 901 patients who underwent cardioversion were studied (VKA [n = 471], DABI [n = 288] and RIVA [n = 141]). In these patients there were no strokes seen during follow-up and 2 TIAs in the DABI group. Bleeding rates were low, with no significant difference between the 3 groups. A total of 680 patients who underwent ablation were studied (VKA [n = 319], DABI [n = 220] and RIVA [n = 171]). There were no strokes reported during follow-up and 3 TIAs: 2 in the VKA group and 1 in the DABI group not resulting in a significant difference between the groups. Bleeding rates were low, with no significant difference between the groups.
Overall, there was a low incidence of adverse events for all anticoagulation regimens. Warfarin, DABI, and RIVA use around the time of the procedure are safe and reasonable options for patients who undergo cardioversion or AF ablation.
在房颤（AF）转复或消融术的围术期管理中，比较传统维生素 K 拮抗剂（VKA）与新型口服抗凝药物方案的数据很少。我们旨在比较 VKA、达比加群（DABI）和利伐沙班（RIVA）抗凝在介入前后的应用结果。
我们研究了 2010 年 10 月至 2013 年 10 月在我们中心接受 AF 转复或消融术的连续患者。有 3 种不同的抗凝治疗组：华法林（VKA）、DABI 和 RIVA。安全性根据中风、短暂性脑缺血发作（TIA）以及临床重要和不重要的出血事件的数量进行评估。
各组间的基线特征平衡良好。平均随访时间为 6 个月（±4 个月）。共研究了 901 例接受转复的患者（VKA [n=471]、DABI [n=288]和 RIVA [n=141]）。在这些患者中，随访期间未发生中风，DABI 组有 2 例 TIA。出血发生率低，3 组间无显著差异。共研究了 680 例接受消融的患者（VKA [n=319]、DABI [n=220]和 RIVA [n=171]）。随访期间未报告中风，有 3 例 TIA：VKA 组 2 例，DABI 组 1 例，两组间无显著差异。出血发生率低，各组间无显著差异。
总体而言，所有抗凝方案的不良事件发生率均较低。华法林、DABI 和 RIVA 在围术期使用是转复或消融 AF 患者的安全合理选择。
