择期心房颤动转复后血栓栓塞和出血并发症：一项全国性队列研究。

Thromboembolic and bleeding complications after elective cardioversion of atrial fibrillation: a nationwide cohort study.

机构信息

Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland.

Jorvi Hospital, Department of Internal Medicine, HUS Helsinki University Hospital, Espoo, Finland.

出版信息

Europace. 2024 Jun 3;26(6). doi: 10.1093/europace/euae131.

DOI:10.1093/europace/euae131

PMID:38829189

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11146156/

Abstract

AIMS

Elective cardioversion (ECV) is routinely used in atrial fibrillation (AF) to restore sinus rhythm. However, it includes a risk of thromboembolism even during adequate oral anticoagulation treatment. The aim of this study was to evaluate the risk of thromboembolic and bleeding complications after ECV in a real-life setting utilizing data from a large AF population.

METHODS AND RESULTS

This nationwide register-based study included all (n = 9625) Finnish AF patients undergoing their first-ever ECV between 2012 and 2018. The thromboembolic and bleeding complications within 30 days after ECV were analysed. The mean age of the patients was 67.7 ± 9.9 years, 61.2% were men, and the mean CHA2DS2-VASc score was 2.6 ± 1.6. Warfarin was used in 6245 (64.9%) and non-vitamin K oral anticoagulants (NOACs) in 3380 (35.1%) cardioversions. Fifty-two (0.5%) thromboembolic complications occurred, of which 62% were ischaemic strokes, 25% transient ischaemic attacks, and 13% other systemic embolisms. Thromboembolic events occurred in 14 (0.4%) NOAC-treated patients and in 38 (0.6%) warfarin-treated patients (odds ratio 0.77; confidence interval: 0.42-1.39). The median time from ECV to the thromboembolic event was 2 days, and 78% of the events occurred within 10 days. Age and alcohol abuse were significant predictors of thromboembolic events. Among warfarin users, thromboembolic complications were more common with international normalized ratio (INR) <2.5 than INR ≥2.5 (0.9% vs. 0.4%, P = 0.026). Overall, 27 (0.3%) bleeding events occurred.

CONCLUSION

The rate of thromboembolic and bleeding complications related to ECV was low without significant difference between NOAC- and warfarin-treated patients. With warfarin, INR ≥2.5 at the time of cardioversion reduced the risk of thromboembolic complications.

摘要

目的

电复律（ECV）通常用于心房颤动（AF）以恢复窦性节律。然而，即使在充分的口服抗凝治疗下，它也存在血栓栓塞的风险。本研究的目的是利用来自大型 AF 人群的数据，在真实环境中评估 ECV 后血栓栓塞和出血并发症的风险。

方法和结果

本项全国范围内基于登记的研究纳入了 2012 年至 2018 年间首次接受 ECV 的所有（n=9625）芬兰 AF 患者。分析了 ECV 后 30 天内的血栓栓塞和出血并发症。患者的平均年龄为 67.7±9.9 岁，61.2%为男性，平均 CHA2DS2-VASc 评分为 2.6±1.6。6245 例（64.9%）使用华法林，3380 例（35.1%）使用非维生素 K 口服抗凝剂（NOACs）。52 例（0.5%）发生血栓栓塞并发症，其中 62%为缺血性脑卒中，25%为短暂性脑缺血发作，13%为其他系统性栓塞。NOAC 治疗组发生血栓栓塞事件 14 例（0.4%），华法林治疗组发生 38 例（0.6%）（比值比 0.77；95%置信区间：0.42-1.39）。从 ECV 到血栓栓塞事件的中位时间为 2 天，78%的事件发生在 10 天内。年龄和酒精滥用是血栓栓塞事件的显著预测因素。华法林使用者中，国际标准化比值（INR）<2.5 时血栓栓塞并发症比 INR≥2.5 时更常见（0.9%比 0.4%，P=0.026）。总体而言，27 例（0.3%）发生出血事件。