Thromboembolic risk in 16 274 atrial fibrillation patients undergoing direct current cardioversion with and without oral anticoagulant therapy
Thromboembolic risk in 16 274 atrial fibrillation patients undergoing direct current cardioversion with and without oral anticoagulant therapy
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DOI：
10.1093/europace/euu189
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发表时间：
2015-01-01
期刊：
影响因子：
6.1
通讯作者：
Torp-Pedersens, Christian
中科院分区：
文献类型：
--
作者：
Hansen, Morten Lock;Jepsen, Rikke Malene H. G.;Torp-Pedersens, Christian
Aims To study the risk of thromboembolism in a nationwide cohort of atrial fibrillation patients undergoing direct current（DC）cardioversion with or without oral anticoagulant coverage.Methods and results A retrospective study of 16 274 patients in丹麦出院后首次DC cardioversion for atrial fibrillation between 2000 and 2008.从丹麦药品统计登记处获得DC心脏复律前90天内和复律后360天内口服抗凝剂治疗的使用情况。通过计算发生率和多变量校正的考克斯比例风险模型估计血栓栓塞的风险。在出院后的最初30天内，既往未接受口服抗凝剂治疗组的血栓栓塞发生率为10.33/100患者-年[n = 5084（31.2%）]，而既往口服抗凝剂治疗组为4.00/100患者-年[n = 11 190（68.8%）]，[与既往未接受口服抗凝剂治疗相关的风险比为2.25; 95%置信区间（CI）为1.43-3.53]。根据CHADS（2）和CHA（2）DS（2）-VASc评分进行血栓栓塞风险分层并没有改变结果。在CHA（2）DS（2）-VASc评分0-1分和CHA（2）DS（2）-VASc评分≥ 2分时，未口服抗凝剂治疗的危险比分别为2.21、0.79-6.77和2.40、1.46-3.95。值得注意的是，在心脏复律后的初始阶段，风险较高，表明无抗凝的DC心脏复律与血栓栓塞之间存在危险关联。
Aims To study the risk of thromboembolism in a nationwide cohort of atrial fibrillation patients undergoing direct current (DC) cardioversion with or without oral anticoagulant coverage.Methods and results A retrospective study of 16 274 patients in Denmark discharged from hospital after a first-time DC cardioversion for atrial fibrillation between 2000 and 2008. Use of oral anticoagulant therapy within 90 days prior and 360 days after DC cardioversion was obtained from the Danish Register of Medicinal Product Statistics. The risk of thromboembolism was estimated by calculating incidence rates and by multivariable adjusted Cox proportional-hazard models. During the initial 30 days following discharge, the thromboembolic incidence rate was 10.33 per 100 patient-years for the no prior oral anticoagulant therapy group [n = 5084 (31.2%)], as compared with 4.00 per 100 patient-years for the prior oral anticoagulant therapy group [n = 11 190 (68.8%)], [hazard ratio associated with no prior oral anticoagulant therapy was 2.25; 95% confidence interval (CI), 1.43-3.53]. Thromboembolic risk stratification by the CHADS(2) and CHA(2)DS(2)-VASc scores did not change the results. Hazard ratio with no oral anticoagulant therapy was 2.21; 95% CI, 0.79-6.77 and 2.40; 95% CI, 1.46-3.95 with CHA(2)DS(2)-VASc score 0-1 and CHA(2)DS(2)-VASc score 2 or more, respectively.Conclusion Direct current cardioversion for atrial fibrillation without oral anticoagulation is associated with a high risk of thromboembolism. Notably, the risk is high in the initial period after cardioversion, indicating a hazardous association between DC cardioversion without anticoagulation and thromboembolism.