Efficacy and Safety of Apixaban in Patients After Cardioversion for Atrial Fibrillation
Efficacy and Safety of Apixaban in Patients After Cardioversion for Atrial Fibrillation
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DOI：
10.1016/j.jacc.2013.09.062
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发表时间：
2014-03-25
影响因子：
24
通讯作者：
Granger, Christopher B.
中科院分区：
文献类型：
--
作者：
Flaker, Greg;Lopes, Renato D.;Granger, Christopher B.
本研究的目的是确定与华法林相比，口服Xa因子抑制剂阿哌沙班（apixaban）治疗的房颤患者在转复后发生主要临床和血栓栓塞事件的风险。背景：房颤患者在复律后可能发生血栓栓塞事件。维生素K拮抗剂和达比加群可以降低这种风险。方法使用亚里士多德（阿哌沙班用于减少房颤卒中和其他血栓栓塞事件）试验的数据，我们对接受心律转复的患者进行了事后分析。结果540例患者共进行了743次复律：阿哌沙班组265例首次复律，华法林组275例。华法林组和阿哌沙班组患者到第一次心脏复律的平均时间分别为243 +/- 231天和251 +/- 248天；75%的心脏复律在1年内发生。各组间基线特征相似。在接受心脏复律的患者中，在30天的随访期间没有发生中风或全身性栓塞。华法林组和阿哌沙班组分别有1例（0.2%）和1例（0.3%）发生心肌梗死。华法林组1例（0.2%）大出血，阿哌沙班组1例（0.3%）大出血。接受华法林治疗的2例（0.5%）患者死亡，接受阿哌沙班治疗的2例（0.6%）患者死亡。结论华法林与阿哌沙班在房颤转复后发生的主要心血管事件较少，且具有可比性。阿哌沙班用于减少房颤卒中和其他血栓栓塞事件[ARISTOTLE]； NCT00412984) (C) 2014年由美国心脏病学会基金会批准
Objectives The aim of this study was to determine the risk of major clinical and thromboembolic events after cardioversion for atrial fibrillation in subjects treated with apixaban, an oral factor Xa inhibitor, compared with warfarin.Background In patients with atrial fibrillation, thromboembolic events may occur after cardioversion. This risk is lowered with vitamin K antagonists and dabigatran.Methods Using data from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, we conducted a post-hoc analysis of patients undergoing cardioversion.Results A total of 743 cardioversions were performed in 540 patients: 265 first cardioversions in patients assigned to apixaban and 275 in those assigned to warfarin. The mean time to the first cardioversion for patients assigned to warfarin and apixaban was 243 +/- 231 days and 251 +/- 248 days, respectively; 75% of the cardioversions occurred by 1 year. Baseline characteristics were similar between groups. In patients undergoing cardioversion, no stroke or systemic emboli occurred in the 30-day follow-up period. Myocardial infarction occurred in 1 patient (0.2%) receiving warfarin and 1 patient receiving apixaban (0.3%). Major bleeding occurred in 1 patient (0.2%) receiving warfarin and 1 patient receiving apixaban (0.3%). Death occurred in 2 patients (0.5%) receiving warfarin and 2 patients receiving apixaban (0.6%).Conclusions Major cardiovascular events after cardioversion of atrial fibrillation are rare and comparable between warfarin and apixaban. (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation [ARISTOTLE]; NCT00412984) (C) 2014 by the American College of Cardiology Foundation