Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy.
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
JACC Clin Electrophysiol. 2018 Jun;4(6):794-806. doi: 10.1016/j.jacep.2018.04.006.
The purpose of this study was to evaluate the safety and efficacy of uninterrupted and interrupted direct oral anticoagulant (DOAC) administration in patients undergoing pulmonary vein isolation (PVI).
The optimal periprocedural management of DOACs in patients undergoing PVI is not well defined, and different strategies are used.
A systematic search of PubMed/MEDLINE, Ovid/MEDLINE, and EMBASE was performed. Three strategies for periprocedural DOAC administration were considered: uninterrupted, mildly interrupted (<12 h), and interrupted (≥12 h). Primary endpoints were major bleeding (MB) and thromboembolic (TE) complications; pooled weighted mean incidence (WMI) was calculated using a random-effects model. A secondary endpoint was the WMI of overall bleeding (OB).
The analysis included 43 studies for a total of 8,362 patients. DOACs showed similar safety and efficacy in the 3 subgroups. The WMI of MB was 1.02%, 1.49%, and 1.17% for the uninterrupted, mildly interrupted, and interrupted strategy, respectively; the WMI of TE complications was 0.16%, 0.46%, and 0.49% for the uninterrupted, mildly interrupted, and interrupted strategy, respectively, with no heterogeneity. OB appeared to be higher in uninterrupted (6.33%) and mildly interrupted (8.62%) groups compared with the interrupted (3.53%), with substantial heterogeneity among studies. No interaction was found between the incidence of MB and TE complications and different DOACs.
In patients undergoing PVI, these 3 anticoagulation strategies may have similar safety and efficacy in terms of MB and TE complications. OB appears to be higher in uninterrupted and mildly interrupted strategies compared with the interrupted strategy. No substantial differences were observed among DOACs regarding the incidence of MB and TE complications.
本研究旨在评估直接口服抗凝剂（DOAC）在接受肺静脉隔离（PVI）治疗的患者中连续和间断给药的安全性和疗效。
目前尚不清楚接受 PVI 治疗的患者中 DOAC 围术期管理的最佳方法，不同策略的应用情况也不同。
系统检索 PubMed/MEDLINE、Ovid/MEDLINE 和 EMBASE 数据库。考虑了三种 DOAC 围术期给药策略：连续给药、轻度间断（<12 小时）和间断（≥12 小时）。主要终点是主要出血（MB）和血栓栓塞（TE）并发症；使用随机效应模型计算加权平均发生率（WMI）。次要终点是总出血（OB）的 WMI。
共纳入 43 项研究，总计 8362 例患者。DOAC 在这 3 个亚组中的安全性和疗效相似。MB 的 WMI 分别为连续、轻度间断和间断策略的 1.02%、1.49%和 1.17%；TE 并发症的 WMI 分别为连续、轻度间断和间断策略的 0.16%、0.46%和 0.49%，各研究间无显著异质性。与间断策略相比，连续（6.33%）和轻度间断（8.62%）组的 OB 似乎更高，各研究间存在显著异质性。未发现 MB 和 TE 并发症的发生率与不同 DOAC 之间存在交互作用。
在接受 PVI 治疗的患者中，这 3 种抗凝策略在 MB 和 TE 并发症方面可能具有相似的安全性和疗效。与间断策略相比，连续和轻度间断策略的 OB 似乎更高。在 MB 和 TE 并发症的发生率方面，不同 DOAC 之间未观察到显著差异。
