A randomized comparison of two direct oral anticoagulants for patients undergoing cardiac ablation with a contemporary warfarin control arm
A randomized comparison of two direct oral anticoagulants for patients undergoing cardiac ablation with a contemporary warfarin control arm
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DOI：
10.1007/s10840-020-00732-y
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发表时间：
2020-04-21
影响因子：
1.8
通讯作者：
Ohishi，Mitsuru
中科院分区：
文献类型：
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作者：
Yoshimoto，Issei;Iriki，Yasuhisa;Ohishi，Mitsuru
背景围手术期直接口服抗凝剂（DOAC）治疗房颤（AF）的安全性和有效性尚不清楚。我们比较了无症状的脑微血栓栓塞症和hemoperandium房颤消融后接受edoxaban，利伐沙班，华法林和正常和低剂量使用edoxaban和rivaroxaban.MethodsThis前瞻性随机研究包括170个连续的房颤患者之间的发病率。入院时服用DOAC的患者被随机分配至依度沙班组或利伐沙班组。在入院时接受华法林治疗的患者继续接受华法林治疗。所有患者进行了AF消融，脑MRI进行评估无症状的脑微血栓栓塞后的一天processed.ResultsSixty患者被分配到edoxaban和63利伐沙班。46例患者继续接受治疗。虽然在25例患者（16.3%）中检测到无症状的脑微血栓栓塞，但各组之间无显著差异。2例患者发生心包积血（利伐沙班组和华法林组各1例）。对于依度沙班或利伐沙班患者，低剂量组（9例患者，25.7%）的无症状脑微血栓栓塞发生率高于正常剂量组（8例患者，10.0%）（p< 0.05）。男性比例（88.0%，69.5%，p < 0.05），既往房颤消融史（64.0%，42.2%，p < 0.05），高血压（68.0%，46.1%，P< 0.05）在脑血栓栓塞患者中显著增高。在使用依度沙班、利伐沙班和华法林的患者中，房颤消融术中的血栓栓塞和血液灌流相似。然而，低剂量DOAC可能会增加无症状卒中的风险。
BackgroundThe safety and efficacy of periprocedural use of direct oral anticoagulants (DOACs) for atrial fibrillation (AF) remain unclear. We compared the incidence of asymptomatic cerebral micro-thromboembolism and hemopericardium following AF ablation among patients receiving edoxaban, rivaroxaban, and warfarin and between normal- and low-dose use of edoxaban and rivaroxaban.MethodsThis prospective randomized study included 170 consecutive AF patients. Patients taking DOACs upon admission to our hospital were randomly assigned to an edoxaban group or to a rivaroxaban group. Warfarin was continued in patients receiving warfarin at admission. All patients underwent AF ablation, and cerebral MRI was performed to evaluate asymptomatic cerebral micro-thromboembolism the day after the procedure.ResultsSixty-one patients were assigned to edoxaban and 63 to rivaroxaban. Warfarin was continued in 46 patients. Although asymptomatic cerebral micro-thromboembolism was detected in 25 patients (16.3%), there were no significant differences among the groups. Hemopericardium occurred in 2 patients (one each in the rivaroxaban and warfarin groups). The incidence of asymptomatic cerebral micro-thromboembolism was higher in the low-dose group (9 patients, 25.7%) than in the normal-dose group (8 patients, 10.0%) for patients prescribed either edoxaban or rivaroxaban (p< 0.05). The proportion of males (88.0%, 69.5%,p< 0.05), history of prior AF ablation (64.0%, 42.2%,p< 0.05), and hypertension (68.0%, 46.1%,p< 0.05) were significantly higher in patients with cerebral thromboembolism.ConclusionsThe incidence of asymptomatic cerebral micro-thromboembolism and hemopericardium in AF ablation was similar among patients using edoxaban, rivaroxaban, and warfarin. However, low doses of DOACs may increase the risk of asymptomatic stroke.