PDF(Pubmed)
Abstract：
UNASSIGNED: Many patients with atrial fibrillation (AF) discontinued oral anticoagulation (OAC) therapy after successful catheter ablation. We aimed to determine the real-world risks and consequences of discontinuing OAC use after catheter ablation for AF.
UNASSIGNED: Patients who underwent successful catheter ablation for AF from January 2004 to December 2020 were divided into continued long-term OAC (On-OAC, n = 1062) and discontinued (Off-OAC, n = 1055) groups. The long-term outcomes including thromboembolic events, major bleeding, all-cause mortality and major adverse cardiovascular events (MACE), were compared between the two groups.
UNASSIGNED: The CHA2DS2-VASc score was 3.44 ± 1.12. After a mean follow-up of 37.09 months, thromboembolism risk was higher and major bleeding risk was lower in the Off-OAC than in the On-OAC group (Both log-rank P < 0.001). CHA2DS2-VASc score-stratified subgroup analysis showed similar cumulative event rates between the two groups in men and women with scores of 2 and 3 (intermediate risk for stroke), respectively, (P > 0.05), except for a higher major bleeding rate in the On-OAC group (P = 0.002). Patients at high risk for stroke (men and women with scores ≥3 and ≥ 4) had better non-thromboembolic and non-MACE results (Both log-rank P < 0.05).
UNASSIGNED: Men with a CHA2DS2-VASc score of 2 and women with a score of 3 had a relatively low incidence of stroke events after successful catheter ablation for AF and may be safe for anticoagulation cessation. Greater benefits from long-term OAC were observed in men with CHA2DS2-VASc score ≥3 and women with score ≥4.
UNASSIGNED: Patients who underwent successful catheter ablation for AF from January 2004 to December 2020 were divided into continued long-term OAC (On-OAC, n = 1062) and discontinued (Off-OAC, n = 1055) groups. The long-term outcomes including thromboembolic events, major bleeding, all-cause mortality and major adverse cardiovascular events (MACE), were compared between the two groups.
UNASSIGNED: The CHA2DS2-VASc score was 3.44 ± 1.12. After a mean follow-up of 37.09 months, thromboembolism risk was higher and major bleeding risk was lower in the Off-OAC than in the On-OAC group (Both log-rank P < 0.001). CHA2DS2-VASc score-stratified subgroup analysis showed similar cumulative event rates between the two groups in men and women with scores of 2 and 3 (intermediate risk for stroke), respectively, (P > 0.05), except for a higher major bleeding rate in the On-OAC group (P = 0.002). Patients at high risk for stroke (men and women with scores ≥3 and ≥ 4) had better non-thromboembolic and non-MACE results (Both log-rank P < 0.05).
UNASSIGNED: Men with a CHA2DS2-VASc score of 2 and women with a score of 3 had a relatively low incidence of stroke events after successful catheter ablation for AF and may be safe for anticoagulation cessation. Greater benefits from long-term OAC were observed in men with CHA2DS2-VASc score ≥3 and women with score ≥4.
摘要：
■许多房颤(AF)患者在成功导管消融术后停止口服抗凝(OAC)治疗。我们旨在确定房颤导管消融术后停用OAC的现实风险和后果。
■从2004年1月至2020年12月成功接受房颤导管消融的患者被分为持续的长期OAC（OAC，n=1062)和停产(Off-OAC，n=1055)组。长期结果包括血栓栓塞事件，大出血,全因死亡率和主要不良心血管事件（MACE），对两组进行比较。
■CHA2DS2-VASc评分为3.44±1.12。经过37.09个月的平均随访，与On-OAC组相比,Off-OAC组的血栓栓塞风险较高,大出血风险较低(两个log-rankP<0.001).CHA2DS2-VASc评分分层亚组分析显示，男性和女性两组的累积事件发生率相似，评分分别为2和3（卒中的中等风险）。分别,（P>0.05），除了OAC组较高的大出血率（P=0.002）。卒中高危患者（评分≥3和≥4分的男性和女性）具有更好的非血栓栓塞和非MACE结果（两个log-rankP<0.05）。
■CHA2DS2-VASc评分为2分的男性和评分为3分的女性房颤导管消融术成功后卒中事件发生率相对较低，抗凝停药可能是安全的。在CHA2DS2-VASc评分≥3的男性和评分≥4的女性中，观察到长期OAC的益处更大。
■从2004年1月至2020年12月成功接受房颤导管消融的患者被分为持续的长期OAC（OAC，n=1062)和停产(Off-OAC，n=1055)组。长期结果包括血栓栓塞事件，大出血,全因死亡率和主要不良心血管事件（MACE），对两组进行比较。
■CHA2DS2-VASc评分为3.44±1.12。经过37.09个月的平均随访，与On-OAC组相比,Off-OAC组的血栓栓塞风险较高,大出血风险较低(两个log-rankP<0.001).CHA2DS2-VASc评分分层亚组分析显示，男性和女性两组的累积事件发生率相似，评分分别为2和3（卒中的中等风险）。分别,（P>0.05），除了OAC组较高的大出血率（P=0.002）。卒中高危患者（评分≥3和≥4分的男性和女性）具有更好的非血栓栓塞和非MACE结果（两个log-rankP<0.05）。
■CHA2DS2-VASc评分为2分的男性和评分为3分的女性房颤导管消融术成功后卒中事件发生率相对较低，抗凝停药可能是安全的。在CHA2DS2-VASc评分≥3的男性和评分≥4的女性中，观察到长期OAC的益处更大。
