经导管主动脉瓣置换术后心房颤动患者直接口服抗凝评分与出血事件的关系：一项回顾性多中心队列研究。
Association Between Direct Oral Anticoagulant Score and Bleeding Events in Patients With Atrial Fibrillation Following Transcatheter Aortic Valve Replacement: A Retrospective Multicenter Cohort Study.
机构信息
Department of Cardiology Gifu Heart Center Gifu Japan.
Department of Cardiology, Faculty of Medicine University of Tsukuba Japan.
出版信息
J Am Heart Assoc. 2024 Nov 19;13(22):e036417. doi: 10.1161/JAHA.124.036417. Epub 2024 Nov 7.
BACKGROUND
The Direct Oral Anticoagulant (DOAC) Score can predict bleeding risk in patients with atrial fibrillation taking DOACs; however, it lacks external validation. Therefore, this study aimed to assess the association between the DOAC Score and bleeding events in patients with atrial fibrillation who underwent transcatheter aortic valve replacement.
METHODS AND RESULTS
This retrospective multicenter cohort study included patients with atrial fibrillation who underwent transcatheter aortic valve replacement, as registered in a Japanese multicenter registry. The primary end point was the incidence of bleeding. Patients were categorized based on their DOAC Score: low and moderate- (≤7 points), high- (8-9 points), and very high-risk (≥10 points) groups. Among 1230 patients (mean age 84.6±5.1 years; 457 men), 465 (37.8%) received a vitamin K antagonist, and the remaining patients received DOACs. The low and moderate-, high-, and very high-risk groups included 380 (30.1%), 497 (40.4%), and 353 patients (28.7%), respectively. The 3-year cumulative incidence of all bleeding events was significantly different among the 3 groups (low and moderate risk: 6.6%, high risk: 6.9%, and very high risk: 14.0%; <0.01). Multivariable Cox regression analysis revealed that significant increments in the DOAC Score were associated with a risk of all bleeding events at 3 years in the overall cohort (hazard ratio [HR], 1.22 [95% CI, 1.08-1.38]; <0.01), in the DOAC cohort (HR, 1.20 [95% CI, 1.01-1.42]; =0.04), and in the vitamin K antagonist cohort (HR, 1.25 [95% CI, 1.04-1.50]; =0.02).
CONCLUSIONS
The DOAC Score was significantly associated with bleeding events in patients with atrial fibrillation after transcatheter aortic valve replacement, aiding in clinical decision-making for anticoagulant management.
REGISTRATION
URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023585; Unique identifier: UMIN000020423.
背景
直接口服抗凝剂（DOAC）评分可预测服用 DOAC 的房颤患者的出血风险；然而，它缺乏外部验证。因此，本研究旨在评估 DOAC 评分与行经导管主动脉瓣置换术的房颤患者出血事件之间的关系。
方法和结果
本回顾性多中心队列研究纳入了在日本多中心登记处登记的行经导管主动脉瓣置换术的房颤患者。主要终点是出血发生率。根据 DOAC 评分将患者分为低危和中危（≤7 分）、高危（8-9 分）和极高危（≥10 分）组。在 1230 例患者（平均年龄 84.6±5.1 岁；457 例男性）中，465 例（37.8%）接受了维生素 K 拮抗剂治疗，其余患者接受了 DOAC 治疗。低危和中危、高危和极高危组分别包括 380 例（30.1%）、497 例（40.4%）和 353 例（28.7%）患者。3 年全因出血事件的累积发生率在 3 组之间存在显著差异（低危和中危组：6.6%，高危组：6.9%，极高危组：14.0%；<0.01）。多变量 Cox 回归分析显示，在整个队列（风险比[HR]，1.22[95%CI，1.08-1.38]；<0.01）、DOAC 队列（HR，1.20[95%CI，1.01-1.42]；=0.04）和维生素 K 拮抗剂队列（HR，1.25[95%CI，1.04-1.50]；=0.02）中，DOAC 评分的显著增加与 3 年时的全因出血事件风险相关。
结论
DOAC 评分与行经导管主动脉瓣置换术后房颤患者的出血事件显著相关，有助于临床决策中抗凝管理。
注册
网址：https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023585；唯一标识符：UMIN000020423。
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