Quevillon Travis, Slade Erik, Michael Faith, Benz Alexander P, McIntyre William F, Parkash Ratika, Healey Jeff S, Ko Dennis T, Shurrab Mohammed
Cardiology Department, Health Sciences North Research Institute, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada.
Department of General Internal Medicine, Queen's University, Kingston, Ontario, Canada.
Heart Rhythm O2. 2024 Sep 26;5(12):942-950. doi: 10.1016/j.hroo.2024.09.011. eCollection 2024 Dec.
There is consensus on the safety of standard dose direct oral anticoagulants (DOACs) for stroke prevention in patients undergoing cardioversion of atrial fibrillation (AF), but outcomes of reduced dose DOACs in this setting remain unclear.
This systematic review and meta-analysis aimed to compare the rate of cardioversion-associated thromboembolic events between patients taking reduced dose DOACs and those receiving standard dose anticoagulation.
A systematic search was conducted for studies published between January 1, 2009, and February 16, 2024 in PubMed, Embase, and Cochrane Central Register of Controlled Trials. The included studies compared the rate of thromboembolic events in patients with AF undergoing cardioversion on reduced dose DOACs with the rate in those on standard dose anticoagulation. Odds ratios were pooled with a random effects model.
We identified 2 randomized controlled trials and 8 cohort studies, which included 5212 patients with AF who underwent cardioversion on anticoagulation (1010 patients on reduced dose DOACs and 4202 patients on standard dose anticoagulation). Follow-up ranged from 3 hours to 90 days after cardioversion. There was a numerically higher rate of thromboembolic events in patients undergoing cardioversion on reduced dose DOACs than in those on standard dose anticoagulation (0.69% vs 0.29%; odds ratio 1.98; 95% confidence interval 0.72-5.45; = .19; I = 0%); however, the difference was not statistically significant.
Our systematic review and meta-analysis suggests that there is a numerically higher risk of thromboembolic events in patients with AF undergoing cardioversion on reduced dose DOACs than in those on standard dose anticoagulation. However, the difference was not statistically significant. These findings raise concern about the safety of reduced dose DOACs in patients undergoing cardioversion.
对于接受心房颤动（AF）复律的患者，标准剂量直接口服抗凝剂（DOACs）用于预防卒中的安全性已达成共识，但在此情况下使用低剂量DOACs的结果仍不明确。
本系统评价和荟萃分析旨在比较服用低剂量DOACs的患者与接受标准剂量抗凝治疗的患者发生复律相关血栓栓塞事件的发生率。
在PubMed、Embase和Cochrane对照试验中心注册库中对2009年1月1日至2024年2月16日发表的研究进行系统检索。纳入的研究比较了接受低剂量DOACs复律的AF患者与接受标准剂量抗凝治疗的患者血栓栓塞事件的发生率。采用随机效应模型汇总比值比。
我们确定了2项随机对照试验和8项队列研究，共纳入5212例接受抗凝复律的AF患者（1010例接受低剂量DOACs，4202例接受标准剂量抗凝治疗）。复律后随访时间为3小时至90天。接受低剂量DOACs复律的患者血栓栓塞事件发生率在数值上高于接受标准剂量抗凝治疗的患者（0.69%对0.29%；比值比1.98；95%置信区间0.72 - 5.45；P = 0.19；I² = 0%）；然而，差异无统计学意义。
我们的系统评价和荟萃分析表明，接受低剂量DOACs复律的AF患者发生血栓栓塞事件的风险在数值上高于接受标准剂量抗凝治疗的患者。然而，差异无统计学意义。这些发现引发了对接受复律的患者使用低剂量DOACs安全性的关注。
