Evaluation of safety and efficacy of periprocedural use of rivaroxaban and apixaban in catheter ablation for atrial fibrillation
Evaluation of safety and efficacy of periprocedural use of rivaroxaban and apixaban in catheter ablation for atrial fibrillation
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DOI：
10.1016/j.jjcc.2016.03.014
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发表时间：
2017-01-01
影响因子：
2.5
通讯作者：
Ohishi, Mitsuru
中科院分区：
文献类型：
--
作者：
Yoshimura, Akino;Iriki, Yasuhisa;Ohishi, Mitsuru
背景：我们之前报道过，与华法林相比，达比加群增加了微血栓栓塞和心包积血的风险。非维生素k拮抗剂口服抗凝剂（NOACs）在心房颤动（AF）消融围手术期应用的安全性存在争议。本研究旨在比较利伐沙班、阿哌沙班和华法林围手术期使用房颤消融时无症状脑微血栓栓塞和心包积血的发生率。方法和结果：本研究是一项前瞻性、随机注册研究。就诊时服用noac的患者随机分为两组；利伐沙班和阿哌沙班。服用华法林的患者继续使用华法林。无症状脑微血栓栓塞在消融术后的第二天通过磁共振成像进行评估。在176例连续患者（101例阵发性房颤，75例持续性房颤）中，55例使用利伐沙班，51例使用阿哌沙班，70例使用华法林。本研究中没有出现症状性脑梗死。无症状脑微血栓栓塞32例（18.4%）；利伐沙班组9例（16.4%），阿哌沙班组10例（20%,p = 0.80; vs.利伐沙班），华法林组13例（18.8%,p = 0.81; vs.利伐沙班）。心包积血5例（2.8%）；2例使用利伐沙班，1例使用阿哌沙班（p = 1.0, vs.利伐沙班），2例使用华法林（p = 1.0, vs.利伐沙班）。在多因素分析中，合并冠状动脉造影（p < 0.05，优势比5.73）是脑血栓栓塞的预测因子。结论：在围手术期使用利伐沙班、阿哌沙班和华法林的房颤消融患者中，无症状脑微血栓栓塞和心包积血的发生率相似。(C) 2016年由Elsevier Ltd代表日本心脏病学院出版。
Background: We previously reported that dabigatran increased the risk of microthromboembolism and hemopericardium compared with warfarin. The safety of non-vitamin-K-antagonist oral anticoagulants (NOACs) in the periprocedural use of atrial fibrillation (AF) ablation is controversial. This study aimed to compare the incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation among periprocedural use of rivaroxaban, apixaban, and warfarin.Methods and Results: This study was a prospective, randomized registry. Patients taking NOACs upon visiting our hospital were randomly assigned into 2 groups; rivaroxaban and apixaban. Warfarin was continued in patients taking warfarin. Asymptomatic cerebral microthromboembolism was evaluated by magnetic resonance imaging on the day after the ablation procedure. In 176 consecutive patients (101 paroxysmal, and 75 persistent AF), rivaroxaban was used in 55, apixaban in 51, and warfarin in 70. There were no symptomatic cerebral infarctions in this study. Asymptomatic cerebral microthromboembolism was detected in 32 (18.4%) patients; nine (16.4%) with rivaroxaban, 10 (20%, p = 0.80; vs. rivaroxaban) with apixaban, and 13 (18.8%, p = 0.81; vs. rivaroxaban) with warfarin. Hemopericardium occurred in 5 (2.8%) patients; 2 with rivaroxaban, 1 with apixaban (p = 1.0; vs. rivaroxaban), and 2 with warfarin (p = 1.0; vs. rivaroxaban). In multivariate analysis, concomitant coronary angiography (p < 0.05, odds ratio 5.73) was a predictor of cerebral thromboembolism.Conclusions: The incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation is similar among the periprocedural use of rivaroxaban, apixaban, and warfarin. (C) 2016 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.