未经批准:很少有大规模,真实世界的研究比较了非抗维生素K抗凝剂(NOACs)和华法林在心房颤动(AF)导管消融(CA)中的疗效和安全性.
未经评估:本次回顾,横断面研究使用了全国性的行政索赔数据库,在现实世界中,比较接受NOAC治疗的患者和接受华法林治疗的配对队列的房颤CA后并发症发生率.在2011年6月至2020年8月期间来自426家医院的32,797,540条记录中,41,347名患者(NOAC的38,065名和华法林的3,282名)被认为是合格的。在执行倾向匹配后,分析了6,564名患者(每组3,282名)。
UNASSIGNED:NOACs组的总并发症发生率明显低于华法林组(2.3%vs.4.0%;P<0.001,比值比[OR]:0.55,95%置信区间[CI]:0.41-0.74)。尽管心脏压塞的发生率没有显着差异(1.0%与1.1%;P=0.90,OR:0.97,95%CI:0.60-1.56)和大出血(0.6%vs.0.7%;P=0.54,OR:0.83,95%CI:0.44-1.52)。输血需求(0.6%vs.1.2%;P=0.02,OR:0.52,95%CI:0.30-0.88)和血管并发症(0.2%vs.0.5%;P=0.02,OR:0.33,95%CI:0.12-0.79)在NOACs组明显低于华法林组。此外,NOACs组的血栓栓塞事件发生率明显低于华法林组(0.5%vs.1.2%;P<0.001,OR:0.36,95%CI:0.19-0.64)。
未经批准:NOAC应被视为接受CA治疗的房颤患者围手术期抗凝治疗的一线治疗。
UNASSIGNED: Few large-scale, real-world studies have compared the efficacy and safety of non-antivitamin K anticoagulants (NOACs) with that of warfarin in catheter ablation (CA) for atrial fibrillation (AF).
UNASSIGNED: This retrospective, cross-sectional study used a nationwide administrative claims database, to compare complication-incidence rates following CA for AF between NOAC-treated patients and warfarin-treated matched cohorts in the real-world. Among the 32,797,540 records between June 2011 and August 2020 from 426 hospitals, 41,347 patients (38,065 on NOACs and 3,282 on Warfarin) were considered eligible. After performing propensity matching, 6,564 patients (3,282 per group) were analyzed.
UNASSIGNED: The overall complication incidence was significantly lower in the NOACs group than in the warfarin group (2.3 % vs. 4.0 %; P < 0.001, odds ratio [OR]: 0.55, 95 % confidence interval [CI]: 0.41-0.74). Although no significant differences in the incidence of cardiac tamponade (1.0 % vs. 1.1 %; P = 0.90, OR: 0.97, 95 % CI: 0.60-1.56) and major bleeding (0.6 % vs. 0.7 %; P = 0.54, OR: 0.83, 95 % CI: 0.44-1.52) were noted, blood transfusion requirements (0.6 % vs. 1.2 %; P = 0.02, OR: 0.52, 95 % CI: 0.30-0.88) and vascular complications (0.2 % vs. 0.5 %; P = 0.02, OR: 0.33, 95 % CI: 0.12-0.79) were significantly lower in the NOACs group than in the warfarin group. Furthermore, the thromboembolic event incidence was significantly lower in the NOACs group than in the warfarin group (0.5 % vs. 1.2 %; P < 0.001, OR: 0.36, 95 % CI: 0.19-0.64).
UNASSIGNED: NOACs should be considered as a first-line therapy for periprocedural anticoagulation in patients undergoing CA for AF.