对心房动进行导管切除后的长期抗凝药停用:ALONE- AF随机临床试验
Daehoon Kim1, Jaemin Shim2, Eue-Keun Choi3
1Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
JAMA
|August 31, 2025
概括
在没有心律失常复发的患者中,停止口服抗凝药可以降低中风和出血的风险. 与继续抗凝治疗相比,这种策略显示出较低的复合结果.
科学领域:
- 心脏病学
- 临床试验
- 前庭的管理
背景情况:
- 对心房动 (AF) 导管切除后的长期抗凝策略的随机临床试验数据有限.
- 接受AF切除的患者往往具有需要谨慎管理的中风风险因素.
研究的目的:
- 在非心律失常术后的患者中,停止治疗与继续服用口服抗凝剂 (OAT) 的临床结果进行比较.
- 在这个特定的患者群体中评估OAT停止的疗效和安全性.
主要方法:
- 在韩国进行的一项840名患者随机临床试验.
- 患有至少一个中风风险因子 (CHA2DS2- VASc评分) 并且没有AF复发后的患者被随机分为1:1停止或继续OAT (直接口服抗凝剂).
- 主要结局:综合性中风,全身栓塞和严重出血2年.
主要成果:
- 主要综合结局发生在停止OAT治疗的患者中的0. 3%,与继续OAT治疗的患者中的2. 2% (P=0. 02).
- 停用OAT显示出较低的缺血性中风发病率 (0. 3% 与 0. 8%) 和显著较低的重大出血率 (0% 与 1. 4%).
- 这项研究纳入了平均CHA2DS2- VASc得分为2. 1的患者,主要是空腹性AF (67. 6%).
结论:
- 在非心律失常复发的选定患者中停止OAT治疗与中风,全身栓塞和严重出血的综合风险较低.
- 这种策略可能为这种群体的长期管理提供更安全的替代方案,因此需要进一步调查.
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