Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Murcia, Spain.
QJM. 2019 Mar 1;112(3):183-188. doi: 10.1093/qjmed/hcy250.
The clinical effect of peri-operative bridging therapy in atrial fibrillation (AF) patients remains unclear given that it may increase bleeding risk without providing significant benefits. We aimed to investigate peri-procedural events in relation to peri-operative use of bridging therapy in AF patients under Vitamin K Antagonists (VKAs).
We included AF patients stable the previous 6 months on VKAs. During a median follow-up of 6.5 years (IQR 4.3-7.9), we recorded all invasive procedures and the peri-operative clinical management. All peri-procedural events (ischaemic stroke/transient ischaemic attack/systemic embolism, clinically relevant non-major bleeding and major bleeding) and severe peri-procedural events (ischaemic stroke/transient ischaemic attack/systemic embolism and major bleeding) suffered until the 30-days post-intervention period were recorded.
We included 1361 patients (48.7% male, median age 76 [IQR 71-81] years). There were 1100 (70.9%) procedures performed using bridging therapy. The rate of any (4.5% vs. 0.7%, P < 0.001) and severe (2.3% vs. 0.0%, P = 0.002) peri-procedural events were higher in patients receiving bridging therapy. Adjusted logistic regressions demonstrated that the bleeding risk of the procedure was related with higher risk of severe peri-procedural events (OR 3.51, 95% CI 1.54-8.01) and peri-procedural events (OR 2.77, 95% CI 1.56-4.91). Importantly, the use of bridging therapy was also independently associated with higher risk of any peri-procedural events (OR 4.32, 95% CI 1.28-14.51).
In this study including AF patients under VKA therapy, the use of bridging therapy as part of the clinical management during an invasive procedure was independently associated with higher risk of any peri-procedural event.
在接受维生素 K 拮抗剂（VKA）治疗的心房颤动（AF）患者中，围手术期桥接治疗的临床效果尚不清楚，因为它可能会增加出血风险，而没有提供显著益处。我们旨在研究与 AF 患者围手术期使用桥接治疗相关的围手术期事件。
我们纳入了过去 6 个月稳定服用 VKA 的 AF 患者。在中位随访 6.5 年（IQR 4.3-7.9）期间，我们记录了所有的侵入性操作和围手术期临床管理。记录了所有围手术期事件（缺血性卒中和短暂性脑缺血发作/全身性栓塞、临床相关非大出血和大出血）和严重围手术期事件（缺血性卒中和短暂性脑缺血发作/全身性栓塞和大出血），直到干预后 30 天。
我们纳入了 1361 名患者（48.7%为男性，中位年龄为 76[IQR 71-81]岁）。1100 名患者（70.9%）接受了桥接治疗。接受桥接治疗的患者围手术期事件发生率（4.5% vs. 0.7%，P<0.001）和严重围手术期事件发生率（2.3% vs. 0.0%，P=0.002）均较高。调整后的逻辑回归表明，手术的出血风险与严重围手术期事件（OR 3.51，95%CI 1.54-8.01）和围手术期事件（OR 2.77，95%CI 1.56-4.91）的风险增加相关。重要的是，桥接治疗的使用也与任何围手术期事件的风险增加独立相关（OR 4.32，95%CI 1.28-14.51）。
在这项包括接受 VKA 治疗的 AF 患者的研究中，作为侵入性操作期间临床管理一部分的桥接治疗的使用与任何围手术期事件的风险增加独立相关。
