Gjermeni Diona, Saglam Nertila Poci, Olivier Christoph B, Kühlkamp Volker
Department of Cardiology and Angiology, Heart Center Freiburg-Bad Krozingen Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
Department of Electrophysiology, Heart Center Bodensee, Konstanz, Germany.
Eur Heart J Open. 2023 Jun 20;3(4):oead065. doi: 10.1093/ehjopen/oead065. eCollection 2023 Jul.
In patients undergoing catheter ablation for atrial fibrillation (AF), direct oral anticoagulants (DOACs) are as effective and safe as the vitamin K antagonist (VKA) warfarin. Phenprocoumon has a different pharmacokinetic profile compared with warfarin and is the most used VKA in Germany. The aim of the study was to compare DOAC with phenprocoumon.
In this retrospective single-centre cohort study, 1735 patients who underwent 2219 consecutive catheter ablations for AF between January 2011 and May 2017 were included. All patients were in-hospital for at least 48 h after catheter ablation. The primary outcome was defined as peri-procedural thrombo-embolic events. The secondary outcome was any bleeding according to the International Society on Thrombosis and Haemostasis (ISTH). The mean age of the patients was 63.3 years. Phenprocoumon was prescribed in 929 (42%) of the cases, and in 697 (31%) dabigatran, 399 (18%) rivaroxaban, and 194 (9%) apixaban. During hospitalization, 37 (1.6%) thrombo-embolic events occurred, including 23 transient ischaemic attacks (TIAs). Compared with the use of phenoprocoumon, the use of DOAC was significantly associated with a lower thrombo-embolic risk [16 (1.2%) vs. 21 (2.2%), odds ratio (OR)], 0.5 [95% confidence interval (CI) 0.2-0.9], = 0.04. No statistically significant association with bleeding risk was observed [phenprocomoun: 122 (13%); DOAC: 163 (12.6%); OR 0.9 (95% CI 0.7-1.2); = 0.70]. Interruption of oral anticoagulation (OAC) was associated with an increased risk for thrombo-embolic complications [OR 2.2 (1.1-4.3); = 0.031], and bleeding [OR 2.5 (95% CI 1.8-3.2), = 0.001].
In patients undergoing catheter ablation for AF, the use of DOAC was associated with a reduced risk of thrombo-embolic events compared with phenprocoumon. Non-interrupted oral anticoagulation (OAC) therapy was associated with a reduced risk of peri-procedural thrombo-embolic and any bleeding complications.
在接受房颤导管消融术的患者中，直接口服抗凝剂（DOACs）与维生素K拮抗剂（VKA）华法林一样有效且安全。苯丙香豆素与华法林相比具有不同的药代动力学特征，是德国最常用的VKA。本研究的目的是比较DOAC与苯丙香豆素。
在这项回顾性单中心队列研究中，纳入了2011年1月至2017年5月期间连续接受2219次房颤导管消融术的1735例患者。所有患者在导管消融术后至少住院48小时。主要结局定义为围手术期血栓栓塞事件。次要结局是根据国际血栓与止血协会（ISTH）定义的任何出血情况。患者的平均年龄为63.3岁。929例（42%）患者使用苯丙香豆素，697例（31%）使用达比加群，399例（18%）使用利伐沙班，194例（9%）使用阿哌沙班。住院期间发生37例（1.6%）血栓栓塞事件，包括23例短暂性脑缺血发作（TIA）。与使用苯丙香豆素相比，使用DOAC与较低的血栓栓塞风险显著相关[16例（1.2%）对21例（2.2%），比值比（OR）0.5，95%置信区间（CI）0.2 - 0.9，P = 0.04]。未观察到与出血风险有统计学意义的关联[苯丙香豆素组：122例（13%）；DOAC组：163例（12.6%）；OR 0.9（95% CI 0.7 - 1.2）；P = 0.70]。口服抗凝药（OAC）中断与血栓栓塞并发症风险增加相关[OR 2.2（1.1 - 4.3）；P = 0.031]，且与出血相关[OR 2.5（95% CI 1.8 - 3.2），P = 0.001]。
在接受房颤导管消融术的患者中，与苯丙香豆素相比，使用DOAC与血栓栓塞事件风险降低相关。不间断的口服抗凝药（OAC）治疗与围手术期血栓栓塞和任何出血并发症风险降低相关。
