Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Street, Tehran, 1411713138, Iran.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
BMC Cardiovasc Disord. 2024 Aug 2;24(1):404. doi: 10.1186/s12872-024-04064-x.
New-onset postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG) surgery, increasing the risk of embolism and stroke. There is a lack of information on the use of anticoagulants in this context. The choice between Warfarin and Direct oral anticoagulants (DOACs) also is not well-established. This randomized study aimed to compare the feasibility and safety of Warfarin and Rivaroxaban in preventing thrombotic events in POAF patients after isolated CABG.
A total of 66 patients were randomized parallelly with 1:1 allocation to receive either Rivaroxaban (n = 34) or Warfarin (n = 32). Major bleeding events within 30 days after discharge were the primary outcome. Secondary outcomes included minor bleeding events and thrombotic episodes. Clinical characteristics, medication regimens, and left atrial diameter were assessed. Statistical analyses were performed using appropriate tests.
No thrombotic episodes were observed in either treatment arm. No major bleeding events occurred in either group. Four minor bleeding events were reported, with no significant difference between the treatment groups (P = 0.6). Patients with atrial fibrillation had significantly larger left atrial diameters compared to those with normal sinus rhythm (40.5 vs. 37.8 mm, P = 0.01).
This pilot study suggests that Warfarin and Rivaroxaban are both safe and effective for preventing thrombotic episodes in POAF patients after isolated CABG. No significant differences in major bleeding events were observed between the two anticoagulants. These findings may support the preference for DOACs like Rivaroxaban due to their convenience and easier maintenance.
Number IRCT20200304046696N1, Date 18/03/2020 https//irct.behdasht.gov.ir/ .
新发术后心房颤动（POAF）是冠状动脉旁路移植术（CABG）后的常见并发症，增加了栓塞和中风的风险。在这种情况下，关于抗凝剂的使用信息不足。华法林和直接口服抗凝剂（DOACs）之间的选择也没有得到很好的确定。这项随机研究旨在比较华法林和利伐沙班在预防孤立性 CABG 后 POAF 患者血栓事件中的可行性和安全性。
总共 66 名患者平行随机分为 1:1 组，分别接受利伐沙班（n=34）或华法林（n=32）治疗。主要结局是出院后 30 天内的大出血事件。次要结局包括小出血事件和血栓事件。评估临床特征、药物治疗方案和左心房直径。使用适当的检验进行统计分析。
在治疗组中均未观察到血栓事件。两组均未发生重大出血事件。报告了 4 例小出血事件，两组之间无显著差异（P=0.6）。房颤患者的左心房直径明显大于窦性心律患者（40.5 毫米 vs. 37.8 毫米，P=0.01）。
这项初步研究表明，华法林和利伐沙班在预防孤立性 CABG 后 POAF 患者的血栓事件中均安全有效。两种抗凝剂之间未观察到主要出血事件的显著差异。这些发现可能支持像利伐沙班这样的 DOAC 的偏好，因为它们方便且更容易维持。
IRCT20200304046696N1，日期 2020 年 3 月 18 日，https//irct.behdasht.gov.ir/ 。
