Santarpia Giuseppe, De Rosa Salvatore, Sabatino Jolanda, Curcio Antonio, Indolfi Ciro
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.
URT-CNR, Department of Medicine, Consiglio Nazionale delle Ricerche, Catanzaro, Italy.
Front Cardiovasc Med. 2017 Dec 21;4:85. doi: 10.3389/fcvm.2017.00085. eCollection 2017.
Atrial fibrillation (AF) is associated with a high risk of thromboembolic stroke and oral anticoagulation therapy (OAT) is able to reduce the rate of ischemic events. Nevertheless, the actual benefit of prolonged OAT after successful radiofrequency catheter ablation (RFCA) is not clear yet.
Scientific investigations were assumed suitable if they assessed the clinical significance of the use of anticoagulation versus no anticoagulation in AF patients undergoing successful RFCA. The odds ratio (OR) with 95% confidence interval (CI) was used as the study summary measure.
At meta-analysis, the rate of total thromboembolic events was not significantly different between the groups (OR 1.83, 95% CI 0.69-4.88; = 0.221), while a lower incidence of total bleeding events in patients not treated with OAT was found (OR 6.5, 95% CI 1.93-21.86; = 0.002).
This meta-analysis raises doubts about the net clinical benefit (NCB) of a long-term prophylactic OAT in patients with AF underwent to successful RFCA. In fact, despite similar rate of thromboembolic events, the apparent increase in bleeding risk suggests caution in prolonging OAT after RFCA. However, the lack of prospective randomized studies does not allow a comprehensive appraisal of this issue. Thus, we propose the design of a novel prospective randomized trial to evaluate the NCB of prolonged OAT after successful RFCA of AF.
心房颤动（AF）与血栓栓塞性中风的高风险相关，口服抗凝治疗（OAT）能够降低缺血性事件的发生率。然而，在成功进行射频导管消融（RFCA）后长期进行OAT的实际益处尚不清楚。
如果科学研究评估了在成功进行RFCA的AF患者中使用抗凝与不使用抗凝的临床意义，则认为这些研究是合适的。采用比值比（OR）及其95%置信区间（CI）作为研究汇总指标。
在荟萃分析中，两组之间的总血栓栓塞事件发生率无显著差异（OR 1.83，95%CI 0.69 - 4.88；P = 0.221），而未接受OAT治疗的患者总出血事件发生率较低（OR 6.5，95%CI 1.93 - 21.86；P = 0.002）。
这项荟萃分析对成功进行RFCA的AF患者长期预防性使用OAT的净临床益处（NCB）提出了质疑。事实上，尽管血栓栓塞事件发生率相似，但出血风险的明显增加表明在RFCA后延长OAT治疗时应谨慎。然而，由于缺乏前瞻性随机研究，无法对该问题进行全面评估。因此，我们建议设计一项新的前瞻性随机试验，以评估AF成功进行RFCA后延长OAT的NCB。
