Goette Andreas, Heidbuchel Hein
St Vincenz Hospital Paderborn, Paderborn, Germany.
Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
Arrhythm Electrophysiol Rev. 2017 Jun;6(2):50-54. doi: 10.15420/aer.2017:3:2.
Anticoagulation is routinely prescribed to patients with persistent AF before cardioversion to reduce the risk of thromboembolic events. As direct oral anticoagulants (DOACs) have a rapid onset of action, a consistent anticoagulant effect, if taken correctly, and do not need monitoring or dose adjustments, there is considerable interest in their use for patients with AF undergoing cardioversion. Post-hoc analyses show that DOACs are safe to use prior to and following cardioversion. In addition, two randomised controlled trials, X-VeRT and ENSURE-AF, have demonstrated the efficacy and safety of the DOACs rivaroxaban and edoxaban, respectively, in this setting. The use of DOACs allows cardioversions to be performed promptly and reduces the number of cancelled procedures compared with the use of warfarin.
在进行心脏复律之前，通常会给持续性房颤患者开具抗凝药物，以降低血栓栓塞事件的风险。由于直接口服抗凝剂（DOACs）起效迅速，若正确服用则抗凝效果持续稳定，且无需监测或调整剂量，因此人们对其用于接受心脏复律的房颤患者十分感兴趣。事后分析表明，DOACs在心脏复律前后使用都是安全的。此外，两项随机对照试验X-VeRT和ENSURE-AF分别证明了DOACs利伐沙班和依度沙班在这种情况下的有效性和安全性。与使用华法林相比，使用DOACs可使心脏复律迅速进行，并减少取消手术的次数。
