Benefits and Risks Associated with Long-term Oral Anticoagulation after Successful Atrial Fibrillation Catheter Ablation: Systematic Review and Meta-analysis.
Benefits and Risks Associated with Long-term Oral Anticoagulation after Successful Atrial Fibrillation Catheter Ablation: Systematic Review and Meta-analysis.
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DOI：
10.1177/10760296221118480
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发表时间：
2022-01
影响因子：
2.9
通讯作者：
Zhong, Jingquan
中科院分区：
文献类型：
--
作者：
Maduray, Kellina;Moneruzzaman, Md;Changwe, Geoffrey J.;Zhong, Jingquan
口服抗凝剂（OAC）可预防血栓栓塞，但大大增加了出血的风险，引起了临床医生的关注。目前的指南缺乏足够的证据支持成功的房颤导管消融（CA）后的长期OAC。在PubMed、Google Scholar、Medline和Scopus中进行了文献检索，以查找比较消融术后房颤（AF）患者继续和停止抗凝治疗的研究。漏斗图和Egger检验检查了潜在偏倚。通过随机效应模型，使用RevMan（5.4）和STATA（17.0）计算总结优势比（OR）和95%置信区间（CI）。分析了20项研究，包括22 429例患者（13 505例非OAC患者）。 检查血栓栓塞事件（TE）的分层CHA 2DS 2-VASc评分≥2有利于继续OAC（OR 1.86; 95% CI：1.02-3.40; P = .04）。敏感性分析表明，这种关联减弱。OAC组的大出血（MB）发生率更高（OR 0.16; 95% CI：0.08-0.95; P < .00001），尤其是颅内出血（ICH）和消化道出血（GI）;（OR 0.17; 95% CI：0.08-0.36; P < .00001）和（OR 0.12; 95% CI：0.04-0.32; P < .0001）。我们的研究结果支持在CHA 2DS 2-VASc评分≥2的患者中持续抗凝治疗。由于结果稳健性降低，仍建议医生酌情处理。
Oral anticoagulation (OAC) prevents thromboembolism yet greatly increases the risk of bleeding, inciting concern among clinicians. Current guidelines lack sufficient evidence supporting long-term OAC following successful atrial fibrillation catheter ablation (CA). A literature search was performed in PubMed, Google Scholar, Medline, and Scopus to seek out studies that compare continued and discontinued anticoagulation in post-ablation Atrial fibrillation (AF) patients. Funnel plots and Egger’s test examined potential bias. Via the random-effects model, summary odds ratios (OR) with 95% confidence intervals (CI) were calculated using RevMan (5.4) and STATA (17.0). Twenty studies, including 22 429 patients (13 505 off-OAC) were analyzed. Stratified CHA2DS2-VASc score ≥2 examining thromboembolic events (TE) favored OAC continuation (OR 1.86; 95% CI: 1.02-3.40; P = .04). Sensitivity analysis demonstrated this association was attenuated. The on-OAC arm had greater incidence of major bleeding (MB) (OR 0.16; 95% CI: 0.08-0.95; P < .00001), particularly intracranial hemorrhage (ICH) and gastrointestinal bleeding (GI); (OR 0.17; 95% CI: 0.08-0.36; P < .00001) and (OR 0.12; 95% CI: 0.04-0.32; P < .0001), respectively. Our findings support sustained anticoagulation in patients with a CHA2DS2-VASc score of ≥2. Due to reduced outcome robustness, physician discretion is still advised.
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