房颤患者在接受电复律或导管消融术时，尽管持续使用非维生素K拮抗剂口服抗凝药治疗，仍发生左心耳血栓形成：达比加群与利伐沙班的比较
Left Atrial Appendage Thrombus Formation Despite Continuous Non-Vitamin K Antagonist Oral Anticoagulant Therapy in Atrial Fibrillation Patients Undergoing Electrical Cardioversion or Catheter Ablation: A Comparison of Dabigatran and Rivaroxaban.
作者信息
Gorczyca Iwona, Chrapek Magdalena, Jelonek Olga, Michalska Anna, Kapłon-Cieślicka Agnieszka, Uziębło-Życzkowska Beata, Budnik Monika, Gawałko Monika, Krzesiński Paweł, Jurek Agnieszka, Scisło Piotr, Kochanowski Janusz, Kiliszek Marek, Gielerak Grzegorz, Filipiak Krzysztof J, Opolski Grzegorz, Wożakowska-Kapłon Beata
机构信息
Collegium Medicum, The Jan Kochanowski University, Kielce 25-369, Poland.
1 Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce 25-736, Poland.
出版信息
Cardiol Res Pract. 2020 Sep 17;2020:1206402. doi: 10.1155/2020/1206402. eCollection 2020.
Left atrial appendage thrombus (LAAT) may be detected by transesophageal echocardiography (TOE) in patients with atrial fibrillation (AF) despite continuous anticoagulation therapy. We examined the factors predisposing to LAAT in patients treated with the anticoagulants dabigatran and rivaroxaban. We retrospectively evaluated 1,256 AF patients from three centres who underwent TOE before electrical cardioversion ( = 611, 51.4%) or catheter ablation ( = 645, 48.6%) from January 2013 to December 2019 and had been on at least three weeks of continuous dabigatran ( = 603, 48%) or rivaroxaban ( = 653, 52%) therapy. Preprocedural TOE diagnosed LAAT in 51 patients (4.1%), including 30 patients (5%) treated with dabigatran and 21 patients (3.2%) treated with rivaroxaban (=0.1145). In multivariate logistic regression, predictors of LAAT in patients treated with dabigatran were non-paroxysmal AF (vs. paroxysmal AF) (OR = 6.2, =0.015), heart failure (OR = 3.22, =0.003), and a eGFR <60 ml/min/1.73 m (OR = 2.65, =0.012); the predictors in patients treated with rivaroxaban were non-paroxysmal AF (vs. paroxysmal AF) (OR = 5.73, =0.0221) and heart failure (OR = 3.19, =0.116). In ROC analysis of the dabigatran group, the area under the curve (AUC) for the CHADS-VASc-RAF score was significantly higher (0.78) than those for the CHADS, CHADS-VASc, and RCHADS scores (0.67, 0.70, and 0.72, respectively). In the rivaroxaban group, the CHADS-VASc-RAF score also performed significantly better (AUC of 0.77) than the CHADS, CHADS-VASc, and RCHADS scores (AUC of 0.66, 0.64, and 0.67, respectively). The risk of LAAT was the same for patients in both treatment groups. In all patients, non-paroxysmal AF or heart failure, and in patients treated with dabigatran an eGFR <60 ml/min/1.73 m, were independent predictors of LAAT. The new CHADS-VASc-RAF scale had the highest predictive value for LAAT in the entire study population.
尽管进行了持续抗凝治疗，但经食管超声心动图（TOE）仍可能在心房颤动（AF）患者中检测到左心耳血栓（LAAT）。我们研究了使用达比加群和利伐沙班抗凝治疗的患者发生LAAT的易感因素。我们回顾性评估了2013年1月至2019年12月期间来自三个中心的1256例AF患者，这些患者在进行电复律（n = 611，51.4%）或导管消融（n = 645，48.6%）之前接受了TOE检查，并且已经接受了至少三周的持续达比加群（n = 603，48%）或利伐沙班（n = 653，52%）治疗。术前TOE诊断出51例（4.1%）患者存在LAAT，其中包括30例（5%）接受达比加群治疗的患者和21例（3.2%）接受利伐沙班治疗的患者（P = 0.1145）。在多因素逻辑回归分析中，接受达比加群治疗的患者发生LAAT的预测因素为非阵发性AF（与阵发性AF相比）（OR = 6.2，P = 0.015）、心力衰竭（OR = 3.22，P = 0.003）和估算肾小球滤过率（eGFR）<60 ml/min/1.73 m²（OR = 2.65，P = 0.012）；接受利伐沙班治疗的患者的预测因素为非阵发性AF（与阵发性AF相比）（OR = 5.73，P = 0.0221）和心力衰竭（OR = 3.19，P = 0.116）。在达比加群组的ROC分析中，CHADS-VASc-RAF评分的曲线下面积（AUC）显著高于CHADS、CHADS-VASc和RCHADS评分（分别为0.78、0.67、0.70和0.72）。在利伐沙班组中，CHADS-VASc-RAF评分的表现也显著优于CHADS、CHADS-VASc和RCHADS评分（AUC分别为0.77、0.66、0.64和0.67）。两个治疗组患者发生LAAT的风险相同。在所有患者中，非阵发性AF或心力衰竭，以及在接受达比加群治疗的患者中eGFR <60 ml/min/1.73 m²，是LAAT的独立预测因素。新的CHADS-VASc-RAF量表在整个研究人群中对LAAT具有最高的预测价值。
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