Non-Vitamin K Antagonist Oral Anticoagulant vs Warfarin for Post Cardiac Surgery Atrial Fibrillation
Non-Vitamin K Antagonist Oral Anticoagulant vs Warfarin for Post Cardiac Surgery Atrial Fibrillation
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DOI：
10.1016/j.athoracsur.2020.12.031
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发表时间：
2021-10-19
影响因子：
4.6
通讯作者：
Ellinor, Patrick T.
中科院分区：
文献类型：
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作者：
Nauffal, Victor;Trinquart, Ludovic;Ellinor, Patrick T.
背景 非瓣膜性心房颤动 (AF) 的治疗指南建议使用非维生素 K 拮抗剂口服抗凝剂 (NOAC) 而不是华法林，但临床试验排除了心脏手术后 AF 的个体。我们试图比较 NOAC 与华法林治疗新发心脏术后 AF 的结果。方法我们检查了胸外科医生协会数据库中 26,522 名心脏术后 AF 患者，这些患者从 2017 年 7 月至 2018 年 12 月期间接受口服抗凝治疗出院。评估了三个主要结局：30 天死亡率、严重出血并发症和中风/短暂性脑缺血发作。次要结局包括术后住院时间、30 天心肌梗死、静脉血栓栓塞和心包积液/心包填塞。 结果 共有 9769 名（36.8%）参与者服用了 NOAC 和 16,753 名（63.2%）华法林。在多变量分析中，抗凝剂类型与 30 天大出血并发症（比值比 [OR]（NOAC/华法林）0.76，95% 置信区间 [CI] 0.49-1.18）、中风/短暂性脑缺血发作（ORNOAC/华法林 0.94，95% CI 0.53-1.67）或死亡率之间没有关联。 （ORNOAC/华法林 1.08，95% CI 0.80-1.45）。根据肾功能或孤立性冠状动脉搭桥术与瓣膜手术进行分层后，主要结果仍然没有差异。此外，30天心肌梗死（ORNOAC/华法林 1.17，95% CI 0.62-2.22）、静脉血栓栓塞（ORNOAC/华法林 0.91，95% CI 0.47-1.78）或心包积液/心包填塞（ORNOAC/华法林 1.09，95% CI）方面没有差异。 0.80-1.47) 两组之间。 NOAC 治疗与术后住院时间缩短半天相关（β(NOAC/华法林) -0.47，95% CI -0.62 至 -0.33）。 结论 与华法林相比，NOAC 与术后住院时间缩短相关，且没有过量出血或其他短期并发症。这些发现支持在中风风险升高和出血风险可接受的心脏术后房颤患者中更广泛地使用 NOAC 作为华法林的安全替代品。 (C) 2021 年胸外科医师协会
BACKGROUND Treatment guidelines for nonvalvular atrial fibrillation (AF) recommend use of non-vitamin K antagonist oral anticoagulants (NOACs) over warfarin, yet clinical trials excluded individuals with post cardiac surgery AF. We sought to compare outcomes with NOACs vs warfarin for new onset post cardiac surgery AF.METHODS We examined 26,522 patients from The Society of Thoracic Surgeons' database with post cardiac surgery AF who were discharged on oral anticoagulation from July 2017-December 2018. Three primary outcomes were evaluated: 30-day mortality, major bleeding complications, and stroke/transient ischemic attack. Secondary outcomes included postoperative length of stay, 30-day myocardial infarction, venous thromboembolism, and pericardial effusion/tamponade.RESULTS A total of 9769 (36.8%) participants were prescribed NOACs and 16,753 (63.2%) warfarin. In multivariable analysis, there was no association between type of anticoagulant and 30-day major bleeding complications (odds ratio [OR](NOAC/warfarin) 0.76, 95% confidence interval [CI] 0.49-1.18), stroke/transient ischemic attack (ORNOAC/warfarin 0.94, 95% CI 0.53-1.67) or mortality (ORNOAC/warfarin 1.08, 95% CI 0.80-1.45). After stratification by renal function or isolated coronary bypass vs valve surgery, there remained no difference in the primary outcomes. Additionally, there was no difference in 30-day myocardial infarction (ORNOAC/warfarin 1.17, 95% CI 0.62-2.22), venous thromboembolism (ORNOAC/warfarin 0.91, 95% CI 0.47-1.78), or pericardial effusion/tamponade (ORNOAC/warfarin 1.09, 95% CI 0.80-1.47) between the 2 groups. NOAC therapy was associated with a half-day reduction in postoperative length of stay (beta(NOAC/warfarin) -0.47, 95% CI -0.62 to -0.33).CONCLUSIONS NOACs are associated with a reduction in postoperative length of stay, without excess bleeding or other short-term complications, compared with warfarin. These findings support the broader use of NOACs as a safe alternative to warfarin in patients with post cardiac surgery AF at elevated stroke risk and acceptable bleeding risk. (C) 2021 by The Society of Thoracic Surgeons