Xing Y, Xu B, Sheng X, Xu C, Peng F, Sun Y, Wang S, Guo H
Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, China.
Department of Cardiology, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, China.
J Clin Pharm Ther. 2018 Jun;43(3):401-407. doi: 10.1111/jcpt.12671. Epub 2018 Feb 26.
Uninterrupted warfarin during cryoballoon ablation (CB-A) of atrial fibrillation (AF) has been widely accepted. However, to our knowledge, no previous studies exist investigating the optimal intensity of anticoagulation with warfarin for CB-A. This study aimed to evaluate the efficacy and safety of uninterrupted low-intensity warfarin for CB-A of AF in the elderly.
Paroxysmal AF patients (age ≥ 70 years) who underwent CB-A were enrolled prospectively. The participants were stratified into 2 groups based on international normalized ratio (INR) before ablation (INR in group A: 1.5 to 2.0; INR in group B: 2.0-2.5). Primary endpoints included periprocedural thromboembolic complications and major bleeding. Secondary endpoints were new asymptomatic cerebral emboli (ACE) and minor bleeding.
A total of 144 patients were enrolled (group A: 65; group B: 79). In group A, the use of concomitant antiplatelet drugs was more common. Also, the mean HAS-BLED score was significantly higher (2.4 ± 0.8 vs 2.0 ± 0.6, P < .01) and the mean activated clotting time (ACT) during the procedure was significantly lower (302 ± 14 s vs 311 ± 11 s, P < .01). Other clinical characteristics were balanced between the 2 groups. No thromboembolic complications and major bleeding occurred in either group. The incidence of periprocedural ACE was comparable between the 2 groups (9.2% vs 6.3%, P = .74). The incidence of minor bleeding in group A and group B was 4.6% and 11.4%, respectively (P = .14).
Compared with standard-intensity warfarin, uninterrupted low-intensity warfarin might not increase the incidence of thromboembolic complications and might be associated with less bleeding risk during the perioperative period of cryoballoon ablation in the elderly. Large trials are needed to confirm these results.
在心房颤动（AF）冷冻球囊消融术（CB - A）期间持续使用华法林已被广泛接受。然而，据我们所知，此前尚无研究探讨用于CB - A的华法林抗凝的最佳强度。本研究旨在评估老年患者AF的CB - A中持续使用低强度华法林的疗效和安全性。
前瞻性纳入接受CB - A的阵发性AF患者（年龄≥70岁）。根据消融术前的国际标准化比值（INR）将参与者分为2组（A组INR：1.5至2.0；B组INR：2.0 - 2.5）。主要终点包括围手术期血栓栓塞并发症和大出血。次要终点为新发无症状脑栓塞（ACE）和小出血。
共纳入144例患者（A组：65例；B组：79例）。A组中联合使用抗血小板药物更为常见。此外，平均HAS - BLED评分显著更高（2.4±0.8 vs 2.0±0.6，P <.01），术中平均活化凝血时间（ACT）显著更低（302±14秒vs 311±11秒，P <.01）。两组间其他临床特征均衡。两组均未发生血栓栓塞并发症和大出血。两组围手术期ACE的发生率相当（9.2% vs 6.3%，P =.74）。A组和B组小出血的发生率分别为4.6%和11.4%（P =.14）。
与标准强度华法林相比，持续使用低强度华法林可能不会增加血栓栓塞并发症的发生率，且在老年患者冷冻球囊消融术的围手术期可能与更低的出血风险相关。需要大型试验来证实这些结果。
