Sunaga Akihiro, Hikoso Shungo, Nakatani Daisaku, Inoue Koichi, Okuyama Yuji, Egami Yasuyuki, Kashiwase Kazunori, Hirata Akio, Masuda Masaharu, Furukawa Yoshio, Watanabe Tetsuya, Mizuno Hiroya, Okada Katsuki, Dohi Tomoharu, Kitamura Tetsuhisa, Komukai Sho, Kurakami Hiroyuki, Yamada Tomomi, Takeda Toshihiro, Kida Hirota, Oeun Bolrathanak, Kojima Takayuki, Minamiguchi Hitoshi, Sakata Yasushi
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan.
Cardiovascular Center, Sakurabashi Watanabe Hospital Osaka Japan.
Circ Rep. 2020 Jul 30;2(9):457-465. doi: 10.1253/circrep.CR-20-0036.
Anticoagulation for patients with atrial fibrillation (AF) complicated by left atrial thrombi (LAT) is a frequent cause of bleeding complications, but risk factors remain unknown. Of 3,139 AF patients who underwent transesophageal echocardiography, 82 with LAT under anticoagulation were included in this study. Patients treated with combination antiplatelet and anticoagulant therapy (n=31) were compared with those receiving anticoagulant monotherapy (n=51) to investigate the effects of antiplatelet agents during anticoagulation on bleeding complications. Over a mean (±SD) follow-up of 878±486 days, bleeding events occurred more frequently in the combination therapy than monotherapy group (58% vs. 20%; P<0.001), but there was no significant difference in embolic events (6.5% vs. 3.9%; P=0.606). Kaplan-Meier analysis also showed a significantly higher rate of bleeding events in the combination therapy group, but no significant difference in the rate of embolic events. Inverse probability of treatment weighting revealed that combination therapy was independently associated with an increased risk of bleeding (hazard ratio [HR] 2.98, 95% confidence interval [CI] 1.14-7.89, P=0.026), but not with the risk of embolic events (HR 0.30, 95% CI 0.04-2.59, P=0.275). Net clinical benefit analysis was almost negative for combination therapy vs. monotherapy. In patients with AF and LAT, combination therapy was significantly associated with an increased risk of bleeding events, but not with a reduced risk of embolic events.
心房颤动（AF）合并左心房血栓（LAT）患者的抗凝治疗是出血并发症的常见原因，但危险因素仍不明确。在3139例行经食管超声心动图检查的AF患者中，本研究纳入了82例正在接受抗凝治疗且合并LAT的患者。将联合抗血小板和抗凝治疗的患者（n = 31）与接受抗凝单一疗法的患者（n = 51）进行比较，以研究抗凝期间抗血小板药物对出血并发症的影响。在平均（±标准差）878±486天的随访期内，联合治疗组的出血事件发生率高于单一疗法组（58%对20%；P<0.001），但栓塞事件发生率无显著差异（6.5%对3.9%；P = 0.606）。Kaplan-Meier分析也显示联合治疗组的出血事件发生率显著更高，但栓塞事件发生率无显著差异。治疗权重逆概率分析显示，联合治疗与出血风险增加独立相关（风险比[HR] 2.98，95%置信区间[CI] 1.14 - 7.89，P = 0.026），但与栓塞事件风险无关（HR 0.30，95% CI 0.04 - 2.59，P = 0.275）。联合治疗与单一疗法相比，净临床效益分析几乎为阴性。在AF合并LAT的患者中，联合治疗与出血事件风险增加显著相关，但与栓塞事件风险降低无关。
