房颤转复后直接口服减少剂量抗凝剂与标准剂量抗凝剂的卒中风险：一项系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2024-12-01 DOI:10.1016/j.hroo.2024.09.011

Travis Quevillon MD , Erik Slade MD , Faith Michael MD , Alexander P. Benz MD, MSc , William F. McIntyre MD, PhD , Ratika Parkash MD, MSc , Jeff S. Healey MD, MSc , Dennis T. Ko MD, MSc , Mohammed Shurrab MD, MSc, PhD

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引用次数: 0

摘要

背景：对于标准剂量直接口服抗凝剂（DOACs）预防房颤（AF）转复患者卒中的安全性已经达成共识，但在这种情况下，减少剂量DOACs的结果仍不清楚。目的：本系统综述和荟萃分析旨在比较服用减少剂量doac和接受标准剂量抗凝治疗的患者的心律转复相关血栓栓塞事件发生率。方法：系统检索2009年1月1日至2024年2月16日在PubMed、Embase和Cochrane Central Register of Controlled Trials上发表的研究。纳入的研究比较了使用低剂量doac进行心脏复律治疗的房颤患者与使用标准剂量抗凝治疗的房颤患者的血栓栓塞事件发生率。优势比与随机效应模型合并。结果：我们纳入了2项随机对照试验和8项队列研究，其中包括5212例接受抗凝治疗的房颤患者（1010例使用减剂量doac， 4202例使用标准剂量抗凝）。复心后随访时间为3小时至90天。使用低剂量doac进行复律治疗的患者血栓栓塞事件发生率高于使用标准剂量抗凝治疗的患者(0.69% vs 0.29%；优势比1.98；95%置信区间0.72-5.45；P = .19；I2 = 0%)；然而，差异无统计学意义。结论：我们的系统回顾和荟萃分析表明，与使用标准剂量抗凝剂的AF患者相比，使用低剂量DOACs进行转复的AF患者发生血栓栓塞事件的风险更高。然而，差异无统计学意义。这些发现引起了人们对心脏复律患者使用低剂量doac的安全性的关注。

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Risk of stroke with reduced dose direct oral anticoagulants vs standard dose anticoagulation after cardioversion of atrial fibrillation: A systematic review and meta-analysis

Background

There is consensus on the safety of standard dose direct oral anticoagulants (DOACs) for stroke prevention in patients undergoing cardioversion of atrial fibrillation (AF), but outcomes of reduced dose DOACs in this setting remain unclear.

Objective

This systematic review and meta-analysis aimed to compare the rate of cardioversion-associated thromboembolic events between patients taking reduced dose DOACs and those receiving standard dose anticoagulation.

Methods

A systematic search was conducted for studies published between January 1, 2009, and February 16, 2024 in PubMed, Embase, and Cochrane Central Register of Controlled Trials. The included studies compared the rate of thromboembolic events in patients with AF undergoing cardioversion on reduced dose DOACs with the rate in those on standard dose anticoagulation. Odds ratios were pooled with a random effects model.

Results

We identified 2 randomized controlled trials and 8 cohort studies, which included 5212 patients with AF who underwent cardioversion on anticoagulation (1010 patients on reduced dose DOACs and 4202 patients on standard dose anticoagulation). Follow-up ranged from 3 hours to 90 days after cardioversion. There was a numerically higher rate of thromboembolic events in patients undergoing cardioversion on reduced dose DOACs than in those on standard dose anticoagulation (0.69% vs 0.29%; odds ratio 1.98; 95% confidence interval 0.72–5.45; P = .19; I² = 0%); however, the difference was not statistically significant.

Conclusion

Our systematic review and meta-analysis suggests that there is a numerically higher risk of thromboembolic events in patients with AF undergoing cardioversion on reduced dose DOACs than in those on standard dose anticoagulation. However, the difference was not statistically significant. These findings raise concern about the safety of reduced dose DOACs in patients undergoing cardioversion.

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来源期刊

Heart Rhythm O2 Cardiology and Cardiovascular Medicine

CiteScore

3.30

自引率

0.00%

发文量

审稿时长

52 days