择期心房颤动转复后抗凝强度与血栓栓塞风险。

Intensity of anticoagulation and risk of thromboembolism after elective cardioversion of atrial fibrillation.

机构信息

Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland; Department of Medicine, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland.

Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland.

出版信息

Thromb Res. 2017 Aug;156:163-167. doi: 10.1016/j.thromres.2017.06.026. Epub 2017 Jun 22.

DOI:10.1016/j.thromres.2017.06.026

PMID:28662483

Abstract

BACKGROUND

Elective cardioversion (ECV) for atrial fibrillation (AF) is associated with a relatively low risk of thromboembolic complications. However, the optimal intensity of anticoagulation for ECV is unknown. We sought to assess the risk of thromboembolism in low (INR 2.0-2.4) vs. high (INR≥2.5) therapeutic range in a large retrospective cohort study.

METHODS

This multi-centre "real world" study included 1424 ECVs in 1021 patients. The primary outcome was a stroke or a transient ischaemic attack (TIA) or a systemic embolus during the 30-day follow-up after ECV.

RESULTS

Altogether 4 (0.3%) strokes, 2 (0.1%) TIAs and 2 (0.1%) bleeds were detected during the 30-day follow-up after ECV. No systemic emboli were detected. There were 2 deaths (0.1%), one associated with a stroke. Median time to stroke/TIA was 4 (IQR 9.5) days and the median CHADS-VASc-score was 2 (IQR 1.25) among patients with thromboembolic events. Mean INR at ECV was 2.7 (SD 0.54) in the study cohort. Patients with INR 2.0-2.4 at ECV had more thromboembolic events compared with patients with INR≥2.5 (5/529 (0.9%) vs. 1/895 (0.1%), p=0.03). Comprehensive postprocedural INR data was available for 733 (71.8%) patients and 1007 cardioversions. At least one subtherapeutic (<2.0) INR value was detected within 21days after 230 (22.8%) ECVs and this drop in INR level was associated with a higher risk for thromboembolic events compared with continuous therapeutic post-cardioversion anticoagulation (1.7% vs 0.3%, p=0.03).

CONCLUSIONS

Our results suggest that the intensity of periprocedural anticoagulation is associated with the risk of thromboembolic events after ECV.

摘要

背景

择期电复律（ECV）治疗心房颤动（AF）与血栓栓塞并发症的风险相对较低相关。然而，ECV 最佳的抗凝强度尚不清楚。我们旨在评估在大型回顾性队列研究中低（INR 2.0-2.4）与高（INR≥2.5）治疗范围的抗凝强度与血栓栓塞风险之间的关系。

方法

这项多中心“真实世界”研究纳入了 1021 例患者的 1424 例 ECV。主要结局为 ECV 后 30 天内发生的卒中或短暂性脑缺血发作（TIA）或全身性栓塞。

结果

ECV 后 30 天内共检测到 4 例（0.3%）卒中、2 例（0.1%）TIA 和 2 例（0.1%）出血。未检测到全身性栓塞。有 2 例死亡（0.1%），其中 1 例与卒中相关。发生血栓栓塞事件的患者中，中位卒中/TIA 时间为 4（IQR 9.5）天，中位 CHADS-VASc 评分为 2（IQR 1.25）。研究队列中 ECV 时的平均 INR 为 2.7（SD 0.54）。ECV 时 INR 为 2.0-2.4 的患者与 INR≥2.5 的患者相比，血栓栓塞事件更多（5/529（0.9%）比 1/895（0.1%），p=0.03）。733 例（71.8%）患者和 1007 次 ECV 可获得全面的术后 INR 数据。在 230 次 ECV 中有 22.8%（230 次）至少检测到一次亚治疗性（<2.0）INR 值，与持续术后抗凝治疗相比，INR 水平下降与血栓栓塞事件风险增加相关（1.7%比 0.3%，p=0.03）。