Finks Shannon W, Dobesh Paul P, Trujillo Toby C, Crossley George H
From the College of Pharmacy, University of Tennessee, Memphis, TN.
College of Pharmacy, University of Nebraska Medical Center, Omaha, NE.
Cardiol Rev. 2018 Sep/Oct;26(5):245-254. doi: 10.1097/CRD.0000000000000188.
As direct oral anticoagulants (DOACs) have demonstrated favorable efficacy and safety outcomes compared with vitamin K antagonists for the treatment and prevention of venous thromboembolism and the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, their role in the management of anticoagulation during electrophysiological procedures continues to evolve. At present, guidelines are limited regarding specific recommendations for the use of DOACs in these clinical settings. Here, we review available data regarding the risks and benefits associated with various periprocedural anticoagulation management approaches when patients receiving DOACs undergo electrophysiologic procedures including cardioversion, ablation, and device implantation. This discussion is intended to provide clinicians with an overview of available evidence and best practices to minimize the risk of both thromboembolic and bleeding events in the periprocedural setting.
与维生素K拮抗剂相比，直接口服抗凝剂（DOACs）在治疗和预防静脉血栓栓塞以及预防非瓣膜性心房颤动患者的中风和全身性栓塞方面已显示出良好的疗效和安全性，它们在电生理手术期间抗凝管理中的作用仍在不断演变。目前，关于在这些临床环境中使用DOACs的具体建议的指南有限。在此，我们回顾了接受DOACs治疗的患者进行包括心脏复律、消融和设备植入在内的电生理手术时，各种围手术期抗凝管理方法相关的风险和益处的现有数据。本次讨论旨在为临床医生提供现有证据和最佳实践的概述，以尽量降低围手术期血栓栓塞和出血事件的风险。
