在成功的心房移除之后,停止口服抗凝药
Tomoya Iwawaki1, Satoshi Yanagisawa1,2, Yasuya Inden1
1Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
JAMA network open
|March 21, 2025
概括
停止使用口服抗凝剂 (OACs) 治疗心房动 (AF) 的导管切除 (CA) 后,会增加血栓栓塞事件,但降低出血. 患者的特征可能会使这些风险和益处分层.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 抗凝疗法是一种抗凝疗法.
背景情况:
- 关于停止使用口服抗凝剂 (OACs) 治疗心房动 (AF) 的导管切除 (CA) 后,缺乏共识.
- 在OAC停止后评估结果对于指导临床实践至关重要.
研究的目的:
- 评估AF患者在CA后停止OAC治疗后的血栓栓塞事件,严重出血和死亡率.
- 为了确定患者的特征,影响CA和OAC管理成功后的预后.
主要方法:
- 对1821名接受首次CA.患者的回顾性队列研究.
- 根据在CA后12个月的OAC继续或停止分组患者.
- 治疗权重的逆概率 (IPTW) 和倾向性得分匹配用于分析.
主要成果:
- 停止OAC与更高的血栓栓塞率 (IR 0.86对0.37每100人年) 和较低的重大出血 (IR 0.10对0.65每100人年) 有关.
- 停止治疗后,在没有症状的AF,LVEF<60%或LA直径≥45mm的患者中,注意到血栓栓塞的风险增加.
- 在停止OACs的HAS-BLED得分≥2的患者中观察到降低了出血风险.
结论:
- 在AF患者成功CA后停止OAC与血栓栓塞事件增加和出血减少有关.
- 停止OAC治疗的净益处因患者个体特征而有所不同.
- 需要进一步的前性研究来证实这些发现并完善管理策略.
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