Heart and Lung Center, Helsinki University Hospital and University of Helsinki.
Heart Center, Turku University Hospital and University of Turku.
Europace. 2018 Apr 1;20(4):565-568. doi: 10.1093/europace/eux116.
Non-vitamin K antagonist oral anticoagulants (NOAC) have been shown to be safe and effective alternatives to warfarin for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF). The aim of this study was to investigate the complications and the use of NOACs in AF patients undergoing elective cardioversion.
This nationwide multicentre study included consecutive elective cardioversions in AF patients treated with NOACs between October 2011 and May 2016. Data on patient characteristics, antithrombotic treatment and acute (<30 days) complications were collected. One thousand twenty-one patients (mean age 64 years, 70% men) underwent 1291 elective cardioversions, of which 680 (52.7%) cardioversions were performed in patients using dabigatran, 431 (33.4%) rivaroxaban, and 159 (12.3%) apixaban. Mean CHA2DS2-VASc score was 1.8 (±1.5). A total of 3 thromboembolic events occurred after the cardioversion (0.2%): 1 patient receiving dabigatran experienced an ischaemic stroke on Day 2 and 1 rivaroxaban treated patient on Day 4. One patient receiving dabigatran experienced a transient ischaemic attack on Day 11. All 3 patients had used recommended doses of the NOAC. A total of 6 (0.5%) clinically relevant, but not serious bleeding events occurred. Only short duration of AF was associated with lower rate of AF recurrence.
Thrombotic and bleeding complications related to NOACs were uncommon (<0.5%) in real life AF patients undergoing elective cardioversion.
非维生素 K 拮抗剂口服抗凝剂（NOAC）已被证明是预防非瓣膜性心房颤动（AF）患者血栓栓塞并发症的安全有效替代华法林的药物。本研究旨在探讨 AF 患者行择期电复律时的并发症和 NOAC 的使用情况。
本项全国多中心研究纳入了 2011 年 10 月至 2016 年 5 月期间使用 NOAC 治疗的 AF 患者行择期电复律的连续病例。收集了患者特征、抗血栓治疗和急性（<30 天）并发症的数据。共 1021 例（平均年龄 64 岁，70%为男性）患者接受了 1291 次择期电复律，其中 680 次（52.7%）电复律在使用达比加群的患者中进行，431 次（33.4%）在使用利伐沙班的患者中进行，159 次（12.3%）在使用阿哌沙班的患者中进行。平均 CHA2DS2-VASc 评分为 1.8（±1.5）。电复律后共发生 3 例血栓栓塞事件（0.2%）：1 例接受达比加群治疗的患者在第 2 天发生缺血性中风，1 例接受利伐沙班治疗的患者在第 4 天发生。1 例接受达比加群治疗的患者在第 11 天发生短暂性脑缺血发作。所有 3 例患者均使用了推荐剂量的 NOAC。共发生 6 例（0.5%）临床相关但不严重的出血事件。仅 AF 持续时间短与较低的 AF 复发率相关。
在接受择期电复律的 AF 患者中，与 NOAC 相关的血栓和出血并发症罕见（<0.5%）。
