Post-cardioversion anticoagulation in atrial fibrillation with left atrial appendage occlusion: Necessary or not?

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

International journal of cardiology Pub Date : 2025-06-19 DOI:10.1016/j.ijcard.2025.133518

Sittinun Thangjui , Angkawipa Trongtorsak , Jakrin Kewcharoen , Sudarshan Balla , Sandeep Arora , David Schwartzman

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引用次数: 0

Abstract

Background

The role of post-cardioversion oral anticoagulation (OAC) in patients with atrial fibrillation (AF) and left atrial appendage occlusion (LAAO) remains unclear. Limited evidence exists regarding stroke, systemic thromboembolism (SSTEs), and bleeding risks in this population.

Objective

To evaluate the clinical outcomes following electrical cardioversion (eCVN) in patients with AF and prior LAAO.

Methods

We conducted a retrospective cohort study using the TriNetX Research Network to identify patients with prior surgical or percutaneous LAAO, no history of stroke, and no OAC use for at least 1 month prior to eCVN for AF between January 1, 2014, and November 1, 2024. Propensity score matching (PSM) was used to compare outcomes between those who received ≥1 month of OAC post-cardioversion (AC group) and those who did not (Non-AC group). Primary outcomes were SSTEs and significant bleeding.

Results

Among 1507 eligible patients, 583 (38.7 %) received post-cardioversion OAC. After PSM, 551 patients per group were analyzed. The AC group had a numerically lower but not statistically significant rate of SSTEs (OR 0.59, 95 % CI: 0.31–1.13) and ischemic stroke/transient ischemic attack (OR 0.69, 95 % CI: 0.35–1.92). Significant bleeding was similar between groups (6.0 % vs. 5.3 %; OR 1.15, 95 % CI: 0.67–1.92).

Conclusion

Among patients with AF and prior surgical and percutaneous LAAO undergoing cardioversion, post-procedure OAC use was not associated with significant differences in SSTEs or bleeding risk. Prospective studies are warranted to inform clinical guidelines.

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左心耳闭塞的房颤转复后抗凝：是否有必要？

背景：转复后口服抗凝（OAC）在房颤（AF）和左心耳闭塞（LAAO）患者中的作用尚不清楚。在这一人群中，关于中风、系统性血栓栓塞（SSTEs）和出血风险的证据有限。目的：评价房颤合并LAAO患者电转复（eCVN）的临床效果。方法：我们使用TriNetX研究网络进行了一项回顾性队列研究，以确定2014年1月1日至2024年11月1日期间，房颤eCVN治疗前至少1个 月未使用OAC的既往手术或经皮LAAO患者。倾向评分匹配（PSM）用于比较转复后接受OAC≥1 个月的患者（AC组）和未接受OAC治疗的患者（非AC组）之间的结果。主要结局为SSTEs和显著出血。结果：在1507例符合条件的患者中，583例（38.7 %）接受了转复后OAC。PSM后，每组551例患者进行分析。AC组SSTEs发生率（OR 0.59, 95 % CI: 0.31-1.13）和缺血性脑卒中/短暂性脑缺血发作发生率（OR 0.69, 95 % CI: 0.35-1.92）在数值上较低，但无统计学意义。两组间显著出血相似(6.0 % vs. 5.3 %；或1.15,95 % ci: 0.67-1.92)。结论：在房颤患者和既往手术和经皮LAAO的心脏转复术中，术后使用OAC与sste或出血风险无显著差异。前瞻性研究有必要为临床指南提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of cardiology 医学-心血管系统

CiteScore

6.80

自引率

5.70%

发文量

758

审稿时长

44 days

期刊介绍： The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.