Oshima Tsukasa, Fujiu Katsuhito, Matsunaga Hiroshi, Matsuda Jun, Matsubara Takumi, Saga Akiko, Yoshida Yuriko, Shimizu Yu, Hasumi Eriko, Oguri Gaku, Kojima Toshiya, Komuro Issei
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan.
Department of Advanced Cardiology, School of Medicine, The University of Tokyo Tokyo Japan.
Circ Rep. 2021 Jul 30;3(9):481-487. doi: 10.1253/circrep.CR-20-0139. eCollection 2021 Sep 10.
In patients undergoing catheter ablation (CA) for atrial fibrillation (AF), the use of uninterrupted direct oral anticoagulants (DOACs) is the current protocol. This study evaluated bleeding complications following the uninterrupted use of 4 DOACs in patients undergoing CA for AF without any change in the dosing regimen. Moreover, we assessed differences between once- and twice-daily DOAC dosing in patients undergoing CA for AF who continued on DOACs without any change in the dosing regimen. This study was a retrospective single-center cohort study of consecutive patients. All patients continued DOACs without interruption or changes to the dosing schedule, even in the case of morning procedures. The primary endpoint was the incidence of major bleeding events within the first 30 days after CA. In all, 710 consecutive patients were included in the study. Bleeding complications were less frequent in the uninterrupted twice- than once-daily DOACs group. However, the incidence of cardiac tamponade across all DOACs was low (0.98%; 7/710), suggesting that uninterrupted DOACs without changes to the dosing regimen may be an acceptable strategy. The rate of total bleeding events, including minor bleeding (12/710; 1.6%), was also satisfactory. Uninterrupted DOACs without any change in dosing regimen for patients undergoing CA for AF is acceptable. Bleeding complications may be less frequent in patients receiving DOACs twice rather than once daily.
在接受心房颤动（AF）导管消融（CA）的患者中，目前的方案是使用不间断的直接口服抗凝剂（DOACs）。本研究评估了在接受CA治疗AF的患者中不间断使用4种DOACs且给药方案无任何改变后的出血并发症。此外，我们评估了在接受CA治疗AF且继续使用DOACs且给药方案无任何改变的患者中，每日一次和每日两次DOAC给药之间的差异。本研究是一项对连续患者进行的回顾性单中心队列研究。所有患者均不间断地继续使用DOACs，且给药时间表无变化，即使是在上午进行手术的情况下。主要终点是CA后30天内主要出血事件的发生率。总共710例连续患者纳入本研究。不间断每日两次DOACs组的出血并发症比每日一次组更少。然而，所有DOACs的心脏压塞发生率较低（0.98%；7/710），这表明不间断使用DOACs且给药方案无变化可能是一种可接受的策略。包括轻微出血（12/710；1.6%）在内的总出血事件发生率也令人满意。对于接受CA治疗AF的患者，不间断使用DOACs且给药方案无任何改变是可以接受的。接受每日两次DOACs治疗的患者出血并发症可能比每日一次的患者更少。
