Fei Zhen-Tao, Yao Peng-Cheng, Chen Mu, Fei Yu-Dong, Li Wei, Zhang Peng-Pai, Sun Jian, Wang Qun-Shan, Li Yi-Gang
Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Heliyon. 2024 Jun 15;10(12):e32516. doi: 10.1016/j.heliyon.2024.e32516. eCollection 2024 Jun 30.
Many patients with atrial fibrillation (AF) discontinued oral anticoagulation (OAC) therapy after successful catheter ablation. We aimed to determine the real-world risks and consequences of discontinuing OAC use after catheter ablation for AF.
Patients who underwent successful catheter ablation for AF from January 2004 to December 2020 were divided into continued long-term OAC (On-OAC, n = 1062) and discontinued (Off-OAC, n = 1055) groups. The long-term outcomes including thromboembolic events, major bleeding, all-cause mortality and major adverse cardiovascular events (MACE), were compared between the two groups.
The CHA2DS2-VASc score was 3.44 ± 1.12. After a mean follow-up of 37.09 months, thromboembolism risk was higher and major bleeding risk was lower in the Off-OAC than in the On-OAC group (Both log-rank P < 0.001). CHA2DS2-VASc score-stratified subgroup analysis showed similar cumulative event rates between the two groups in men and women with scores of 2 and 3 (intermediate risk for stroke), respectively, (P > 0.05), except for a higher major bleeding rate in the On-OAC group (P = 0.002). Patients at high risk for stroke (men and women with scores ≥3 and ≥ 4) had better non-thromboembolic and non-MACE results (Both log-rank P < 0.05).
Men with a CHA2DS2-VASc score of 2 and women with a score of 3 had a relatively low incidence of stroke events after successful catheter ablation for AF and may be safe for anticoagulation cessation. Greater benefits from long-term OAC were observed in men with CHA2DS2-VASc score ≥3 and women with score ≥4.
许多心房颤动（AF）患者在导管消融成功后停用了口服抗凝（OAC）治疗。我们旨在确定房颤导管消融术后停用OAC治疗的实际风险和后果。
将2004年1月至2020年12月期间成功接受房颤导管消融的患者分为长期持续使用OAC组（On - OAC，n = 1062）和停用OAC组（Off - OAC，n = 1055）。比较两组的长期结局，包括血栓栓塞事件、大出血、全因死亡率和主要不良心血管事件（MACE）。
CHA2DS2 - VASc评分为3.44±1.12。平均随访37.09个月后，Off - OAC组的血栓栓塞风险高于On - OAC组，大出血风险低于On - OAC组（对数秩检验P均<0.001）。CHA2DS2 - VASc评分分层亚组分析显示，在卒中风险为中级（评分为2和3）的男性和女性中，两组的累积事件发生率相似（P>0.05），但On - OAC组的大出血发生率较高（P = 0.002）。卒中高危患者（男性和女性评分≥3和≥4）的非血栓栓塞和非MACE结局更好（对数秩检验P均<0.05）。
CHA2DS2 - VASc评分为2的男性和评分为3的女性在房颤导管消融成功后卒中事件发生率相对较低，停用抗凝治疗可能是安全的。CHA2DS2 - VASc评分≥3的男性和评分≥4的女性从长期OAC治疗中获益更大。
