Trends and Outcomes of Oral Anticoagulation With Direct Current Cardioversion for Atrial Fibrillation/Flutter at an Academic Medical Center.
Trends and Outcomes of Oral Anticoagulation With Direct Current Cardioversion for Atrial Fibrillation/Flutter at an Academic Medical Center.
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DOI：
10.14740/cr1352
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发表时间：
2022-04
影响因子：
1.9
通讯作者：
Smyth S
中科院分区：
文献类型：
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作者：
Arshad S;Davis GA;Amir M;Goldberg YH;Gupta VA;Abdel-Latif AK;Smyth S
越来越多的报告表明直接口服抗凝剂（DOAC）在电复律中的安全使用。本研究的目的是评估与心脏复律抗凝相关的趋势和30天结局。纳入了2015年1月至2020年10月接受电击复律并随访30天的患者;记录了包括卒中、短暂性脑缺血发作、颅内出血（ICH）和胃肠道大出血在内的结局。在515例患者中，351例（68%）为男性，164例（32%）为女性，平均CHA 2DS 2 VASc评分为2.6 ± 1.6。阿哌沙班的门诊使用率从2015年的10%增加到2020年的46%（P < 0.001），华法林的使用率从2015年的24%下降到2020年的10%（P = 0.023）。阿哌沙班用于心脏复律的围手术期使用从2015年的32%增加到2020年的35%（P = 0.317），而华法林的使用从2015年的23%下降到2020年的14%（P = 0.164）。出院时，阿哌沙班处方从2015年的21%增加到2020年的61%（P < 0.001），而华法林处方从2015年的30%下降到2020年的13%（P = 0.009）。心脏复律后30天内未记录到ICH。4例（0.7%）患者发生缺血性卒中，其中1/338例（0.29%）接受DOAC治疗，1/124例（0.8%）接受华法林治疗，2/36例（5.5%）患者在心脏复律后未接受抗凝治疗。口服抗凝治疗的患者中有7例（1%）严重胃肠道出血事件，其中4例（3%）接受华法林治疗，3例（0.8%）接受DOAC治疗。我们的研究表明，DOAC用于心脏复律的使用越来越多且安全。心脏复律后30天缺血性中风的发生率较低，并且仅发生在重症监护室收治的患者中。
Increasing reports suggest the safe use of direct oral anticoagulants (DOACs) in electrical cardioversion. The aim of this study was to assess the trends and 30-day outcomes associated with anticoagulation for cardioversion. Patients who underwent electrical cardioversion from January 2015 to October 2020 with a 30-day follow-up were included; and outcomes including stroke, transient ischemic attack, intracranial hemorrhage (ICH), and major gastrointestinal bleeding were recorded. Of the 515 patients, 351 (68%) were men and 164 (32%) were women, with a mean CHA2DS2VASc score of 2.6 ± 1.6. Outpatient apixaban use increased from 10% in 2015 to 46% in 2020 (P < 0.001) with a decline in the use of warfarin from 24% in 2015 to 10% in 2020 (P = 0.023). Apixaban use peri-procedurally for cardioversion increased from 32% in 2015 to 35% in 2020 (P = 0.317), while warfarin use decreased from 23% in 2015 to 14% in 2020 (P = 0.164). At discharge, apixaban prescriptions increased from 21% in 2015 to 61% in 2020 (P < 0.001), while warfarin prescriptions declined from 30% in 2015 to 13% in 2020 (P = 0.009). No ICH was recorded in the 30 days after cardioversion. Ischemic stroke occurred in four (0.7%) patients with one (0.29%) of the 338 patients on a DOAC, one (0.8%) of the 124 patients on warfarin and two (5.5%) of the 36 patients not receiving anticoagulation post cardioversion. There were seven (1%) major gastrointestinal bleeding events in patients on oral anticoagulation, of which four (3%) were on warfarin and three (0.8%) were on DOACs. Our study shows the increasing and safe use of DOACs for the purpose of cardioversion. The rates of 30-day ischemic stroke post cardioversion were low and only occurred in patients admitted in the intensive care unit.
DOI：
10.1111/anec.12766
发表时间：
2020-09
期刊：
Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
影响因子：
--
作者：
Itäinen-Strömberg S;Hekkala AM;Aro AL;Vasankari T;Airaksinen KEJ;Lehto M
通讯作者：
Lehto M