Sagawa Yuichiro, Nagata Yasutoshi, Yamaguchi Tetsuo, Iwai Takamasa, Yamaguchi Junji, Hijikata Sadahiro, Watanabe Keita, Masuda Ryo, Miyazaki Ryoichi, Miwa Naoyuki, Sekigawa Masahiro, Hara Nobuhiro, Nozato Toshihiro, Hirao Kenzo
Department of Cardiology Japanese Red Cross Musashino Hospital Tokyo Japan.
Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan.
J Arrhythm. 2018 Jun 4;34(4):428-434. doi: 10.1002/joa3.12079. eCollection 2018 Aug.
Oral anticoagulants, including direct oral anticoagulants (DOACs), are usually required in atrial fibrillation (AF) patients who are at a high risk of thromboembolism (TE), even if they had undergone catheter ablation (CA). Although several studies have reported the safety and efficacy of DOACs around CA in AF patients, there are only limited data regarding the midterm incidence of TE and bleeding complications post-CA among AF patients treated with warfarin or DOACs.
We studied 629 AF patients (mean age: 65.3 ± 10.3 years; 442 men) undergoing CA, to calculate the midterm incidence of TE and bleeding complications associated with warfarin or DOACs.
In total, 292 patients used warfarin and 337 used DOACs (dabigatran: 90 patients; rivaroxaban: 137; and apixaban: 110). At baseline, the CHA2DS2-VASc and HAS-BLED scores were similar between the 2 groups. During a median follow-up period of 7 months, no TE complications occurred. The warfarin group had a significantly higher bleeding event rate than did the DOACs group (all bleeding complications: 32 [11.0%] vs 15 [4.5%], respectively, = .002). The rate of all bleeding complications was significantly higher in the warfarin group than in the DOACs group (10.1% vs 3.7%, respectively, at 10 months; = .024). In Cox proportional hazards modeling, DOAC use was significantly associated with a decreased risk of bleeding (adjusted hazard ratio: 0.497; 95% confidence interval: 0.261-0.906, = .022).
Direct oral anticoagulant use in AF patients undergoing CA may be associated with a similar risk of TE as warfarin but is associated with a lower risk of bleeding.
对于有血栓栓塞（TE）高风险的心房颤动（AF）患者，即使已经接受了导管消融（CA），通常也需要使用口服抗凝药，包括直接口服抗凝药（DOACs）。尽管有几项研究报告了DOACs在AF患者CA前后的安全性和有效性，但关于接受华法林或DOACs治疗的AF患者CA后TE和出血并发症的中期发生率的数据仍然有限。
我们研究了629例接受CA的AF患者（平均年龄：65.3±10.3岁；442例男性），以计算与华法林或DOACs相关的TE和出血并发症的中期发生率。
总共有292例患者使用华法林，337例使用DOACs（达比加群：90例；利伐沙班：137例；阿哌沙班：110例）。在基线时，两组的CHA2DS2-VASc和HAS-BLED评分相似。在中位随访期7个月内，未发生TE并发症。华法林组的出血事件发生率明显高于DOACs组（所有出血并发症：分别为32例[11.0%]和15例[4.5%]，P = 0.002）。华法林组所有出血并发症的发生率在10个月时明显高于DOACs组（分别为10.1%和3.7%，P = 0.024）。在Cox比例风险模型中，使用DOACs与出血风险降低显著相关（调整后的风险比：0.497；95%置信区间：0.261-0.906，P = 0.022）。
在接受CA的AF患者中使用直接口服抗凝药可能与华法林有相似的TE风险，但出血风险较低。
