Risk of Thromboembolism Associated With Atrial Fibrillation Following Noncardiac Surgery
Risk of Thromboembolism Associated With Atrial Fibrillation Following Noncardiac Surgery
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DOI：
10.1016/j.jacc.2018.07.088
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发表时间：
2018-10-23
影响因子：
24
通讯作者：
Fosbol, Emil L.
中科院分区：
文献类型：
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作者：
Butt, Jawad H.;Olesen, Jonas B.;Fosbol, Emil L.
背景在非心脏手术后发生新发术后心房颤动（POAF）的患者中血栓栓塞的长期风险是未知的，并且缺乏在这种情况下预防中风的数据。非瓣膜性房颤（NVAF）。方法：使用丹麦全国登记处，作者确定了1996年至2015年非心脏手术后发生POAF的所有患者。按年龄、性别、心力衰竭、高血压、糖尿病、既往血栓栓塞、缺血性心脏病和诊断年份与非手术NVAF患者以1：4的比例匹配。比较血栓栓塞的长期风险进行了多变量考克斯回归models.Results在接受非心脏手术的患者中，6,048（0.4%）开发POAF住院期间，最高的发病率后胸/肺，血管和腹部手术。共有3，830例POAF患者与15，320例NVAF患者匹配。分别有24.3%和41.3%的患者在出院后30天内开始口服抗凝治疗（p值< 0.001）。POAF和NVAF患者的血栓栓塞长期风险相似（31.7例事件vs 29.9例事件/1,000人年;风险比[HR]：0.95; 95%置信区间[CI]：0.85 - 1.07）。随访期间抗凝治疗与POAF患者血栓栓塞事件风险显著降低相关（HR：0.52; 95% CI：0.40 - 0.67）以及NVAF（HR：0.56; 95% CI：结论：非心脏手术后新发POAF与术后长期抗凝治疗相关，血栓栓塞的长期风险与NVAF相似。(c)2018年由美国心脏病学会基金会。
BACKGROUND The long-term risk of thromboembolism in patients developing new-onset post-operative atrial fibrillation (POAF) following noncardiac surgery is unknown, and data on stroke prophylaxis in this setting are lacking.OBJECTIVES The purpose of this study was to assess the long-term risk of thromboembolism in patients developing new-onset POAF following noncardiac surgery relative to patients with nonsurgical, nonvalvular atrial fibrillation (NVAF).METHODS Using Danish nationwide registries, the authors identified all patients who developed POAF following noncardiac surgery from 1996 to 2015. These were matched by age, sex, heart failure, hypertension, diabetes, previous thromboembolism, ischemic heart disease, and year of diagnosis to patients with nonsurgical NVAF in a 1: 4 ratio. Comparative long-term risk of thromboembolism was examined by multivariable Cox regression models.RESULTS In patients undergoing noncardiac surgery, 6,048 (0.4%) developed POAF during hospitalization, with the highest incidences following thoracic/pulmonary, vascular, and abdominal surgery. A total of 3,830 patients with POAF were matched with 15,320 patients with NVAF. Oral anticoagulation therapy was initiated within 30 days post-discharge in 24.3% and 41.3% of these patients, respectively (p value < 0.001). The long-term risk of thromboembolism was similar in patients with POAF and NVAF (31.7 events vs. 29.9 events per 1,000 person years; hazard ratio [HR]: 0.95; 95% confidence interval [CI]: 0.85 to 1.07). Anticoagulation therapy during follow-up was associated with a comparably lowered risk of thromboembolic events in patients with POAF (HR: 0.52; 95% CI: 0.40 to 0.67) as well as NVAF (HR: 0.56; 95% CI: 0.51 to 0.62) compared with no anticoagulation therapy.CONCLUSIONS New-onset POAF following noncardiac surgery was associated with a long-term risk of thromboembolism similar to NVAF. (c) 2018 by the American College of Cardiology Foundation.