McGill University Health Center, 1650 Cedar Ave, Room E5-200, Montreal, QC, Canada H3G 1A4.
Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada.
Europace. 2017 Oct 1;19(10):1630-1636. doi: 10.1093/europace/euw409.
Cardiac implantable electronic device (CIED) surgery is commonly performed in patients with atrial fibrillation (AF). The current analysis was undertaken to compare peri-operative anticoagulation management, bleeding, and thrombotic events in AF patients treated with dabigatran vs. warfarin.
This study included 611 patients treated with dabigatran vs. warfarin who underwent CIED surgery during the RE-LY trial. Among 201 warfarin-treated patients, warfarin was interrupted a median of 144 (inter-quartile range, IQR: 120-216) h, and 37 (18.4%) patients underwent heparin bridging. In dabigatran-treated patients (216 on 110 mg bid and 194 on 150 mg bid), the duration of dabigatran interruption was a median of 96 (IQR: 61-158) h. Pocket hematomas occurred in 9 (2.20%) patients on dabigatran and 8 (3.98%) patients on warfarin (P = 0.218). The occurrence of pocket hematomas was lower with dabigatran compared with warfarin with heparin bridging (RD: -8.62%, 95% CI: -24.15 to - 0.51%, P = 0.034) but not when compared with warfarin with no bridging (P = 0.880). Ischemic stroke occurred in 2 (0.3%) patients; one in the warfarin group (without bridging) and one in the dabigatran 150 mg bid group (P = 0.735).
In patients treated with dabigatran undergoing CIED surgery, interruption of dabigatran is associated with similar or lower incidence of pocket hematoma, when compared with warfarin interruption without or with heparin bridging, respectively. Whether uninterrupted dabigatran can reduce pocket hematoma or ischemic stroke remains to be evaluated.
心脏植入式电子设备 (CIED) 手术通常在心房颤动 (AF) 患者中进行。目前的分析旨在比较接受达比加群与华法林治疗的 AF 患者围手术期抗凝管理、出血和血栓事件。
本研究纳入了在 RELY 试验中接受达比加群与华法林治疗并行 CIED 手术的 611 例患者。在 201 例华法林治疗的患者中，华法林中断中位时间为 144（四分位距，IQR：120-216）小时，37 例（18.4%）患者接受肝素桥接。在达比加群治疗的患者（110mg bid 组 216 例和 150mg bid 组 194 例）中，达比加群中断中位时间为 96（IQR：61-158）小时。达比加群组发生 9 例（2.20%）和华法林组发生 8 例（3.98%）囊袋血肿（P=0.218）。与华法林无桥接相比，达比加群的囊袋血肿发生率低于华法林（RD：-8.62%，95%CI：-24.15 至-0.51%，P=0.034），但与华法林肝素桥接相比无差异（P=0.880）。发生缺血性脑卒中 2 例（0.3%）；华法林组（无桥接）1 例，达比加群 150mg bid 组 1 例（P=0.735）。
在接受达比加群治疗并行 CIED 手术的患者中，与华法林无桥接或肝素桥接相比，达比加群中断与较低或相似的囊袋血肿发生率相关。未中断的达比加群是否能降低囊袋血肿或缺血性脑卒中的发生仍有待评估。
