左心耳封堵与非维生素 K 拮抗剂口服抗凝剂在房颤中的应用效果比较。
Outcomes of left atrial appendage occlusion vs. non-vitamin K antagonist oral anticoagulants in atrial fibrillation.
机构信息
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
Department of Cardiology, Hospital Clínico Universitario Virgen de La Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain.
出版信息
Clin Res Cardiol. 2022 Sep;111(9):1040-1047. doi: 10.1007/s00392-021-01983-z. Epub 2022 Jan 7.
BACKGROUND
The effects of left atrial appendage (LAA) occlusion compared to non-vitamin K antagonist oral anticoagulant (NOAC) therapy in patients with atrial fibrillation (AF) remain unknown.
AIMS
We aimed to evaluate the outcomes in patients with AF who received LAA occlusion vs. NOAC therapy.
METHODS
We utilised data from TriNetX which is a global federated health research network currently containing data for 88.5 million patients. ICD-10 codes were employed to identify AF patients treated with either LAA occlusion or NOAC between 1st December 2010 and 17th January 2019. Clinical outcomes of interest were analysed up to 2 years.
RESULTS
108,697 patients were included. Patients who underwent LAA occlusion were younger, more likely to be white Caucasian and male, had a greater incidence of comorbidities, and were less likely to be prescribed other cardiovascular medications. Using propensity score matching, the risk of all-cause mortality was significantly lower among patients who received LAA occlusion compared to NOAC therapy [1.51% vs. 5.60%, RR 0.27 (95% CI 0.14-0.54)], but there were no statistical differences in the composite thrombotic or thromboembolic events [8.17% vs. 7.72%, RR 1.06 (95% CI 0.73-1.53)], ischaemic stroke or TIA [4.69% vs. 5.45%, RR 0.86 (95% CI 0.54-1.38)], venous thromboembolism [1.66% vs. 1.51%, RR 1.10 (95% CI 0.47-2.57)] and intracranial haemorrhage [1.51% vs. 1.51%, RR 1.00 (95% CI 0.42-2.39)].
CONCLUSION
Overall, LAA occlusion might be a suitable alternative to NOAC therapy for stroke prevention in patients with AF.
背景
左心耳（LAA）封堵术与非维生素 K 拮抗剂口服抗凝剂（NOAC）治疗在房颤（AF）患者中的效果尚不清楚。
目的
我们旨在评估接受 LAA 封堵术与 NOAC 治疗的 AF 患者的结局。
方法
我们利用了 TriNetX 的数据，这是一个全球联邦健康研究网络，目前包含了 8850 万患者的数据。使用 ICD-10 代码来识别 2010 年 12 月 1 日至 2019 年 1 月 17 日期间接受 LAA 封堵术或 NOAC 治疗的 AF 患者。分析了至 2 年的临床结局。
结果
共纳入 108697 例患者。接受 LAA 封堵术的患者年龄较小，更可能是白种人且为男性，合并症发生率更高，并且不太可能同时服用其他心血管药物。通过倾向评分匹配，与接受 NOAC 治疗的患者相比，接受 LAA 封堵术的患者全因死亡率显著降低[1.51%比 5.60%，RR 0.27（95%CI 0.14-0.54)]，但在复合血栓或血栓栓塞事件[8.17%比 7.72%，RR 1.06（95%CI 0.73-1.53)]、缺血性卒中和 TIA[4.69%比 5.45%，RR 0.86（95%CI 0.54-1.38)]、静脉血栓栓塞[1.66%比 1.51%，RR 1.10（95%CI 0.47-2.57)]和颅内出血[1.51%比 1.51%，RR 1.00（95%CI 0.42-2.39)]方面无统计学差异。
结论
总体而言，LAA 封堵术可能是 AF 患者预防卒中的一种替代 NOAC 治疗的方法。
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