{"title":"房颤导管消融后长期使用与停用直接口服抗凝剂的评估——ryouma注册亚分析","authors":"Yuka Oda, Akihiko Nogami, Yuki Komatsu, Kyoko Soejima, Itsuro Morishima, Kenichi Hiroshima, Ritsushi Kato, Satoru Sakagami, Fumiharu Miura, Keisuke Okawa, Masayuki Fukuzawa, Atsushi Takita, Kikuya Uno, Koichiro Kumagai, Takashi Kurita, Masahiko Gosho, Tomoko Ishizu, Kazutaka Aonuma, the RYOUMA Investigators","doi":"10.1111/anec.70067","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The relationship between oral anticoagulant (OAC) status after catheter ablation (CA) for atrial fibrillation (AF) and the risks of ischemic stroke or major bleeding events is still unknown.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This is a subanalysis of the RYOUMA registry, a prospective multicenter observational study of Japanese patients who underwent CA for AF in 2017–2018.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of the 2844 patients, the rate of DOAC continuation was 48.1%, 69.6%, and 80.9% in patients with a CHADS2 score of 0–1, 2, and 3–6, respectively. Among the patients taking DOACs with a CHADS2 score of 0–1 and 2, the incidence rates of major bleeding were significantly higher than those of ischemic stroke or systemic embolic events (SEEs) (1.3%/year [95% CI, 0.6–2.1] vs. 0.3%/year [95% CI, 0.0–0.7], <i>p</i> = 0.019; 1.8%/year [95% CI, 0.6–3.0] vs. 0.2%/year [95% CI, 0.0–0.6], <i>p</i> = 0.018, respectively). However, there was no difference between the incidence rates of major bleeding events and ischemic stroke or SEEs in patients taking DOACs with a CHADS2 score of 3–6 (1.6%/year [95% CI, 0.2–3.0] vs. 1.0%/year [95% CI, 0.0–2.1], <i>p</i> = 0.474).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>In patients with a CHADS2 score of 2, those who continued taking DOACs had a higher incidence rate of major bleeding events compared to ischemic stroke/SEEs, similar to those with a CHADS2 score of 0–1. Conversely, in patients with a CHADS2 score of 3–6, the incidence rates of both ischemic stroke/SEEs and major bleeding were similarly high.</p>\n \n <p><b>Trial Registration:</b> The study was registered as UMIN000026092 (University Hospital Medical Information Network-Clinical Trial Registry)</p>\n </section>\n </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1000,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70067","citationCount":"0","resultStr":"{\"title\":\"Assessment of Long-Term Use Versus Discontinuation of Direct Oral Anticoagulant After Catheter Ablation for Atrial Fibrillation—RYOUMA Registry Subanalysis\",\"authors\":\"Yuka Oda, Akihiko Nogami, Yuki Komatsu, Kyoko Soejima, Itsuro Morishima, Kenichi Hiroshima, Ritsushi Kato, Satoru Sakagami, Fumiharu Miura, Keisuke Okawa, Masayuki Fukuzawa, Atsushi Takita, Kikuya Uno, Koichiro Kumagai, Takashi Kurita, Masahiko Gosho, Tomoko Ishizu, Kazutaka Aonuma, the RYOUMA Investigators\",\"doi\":\"10.1111/anec.70067\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>The relationship between oral anticoagulant (OAC) status after catheter ablation (CA) for atrial fibrillation (AF) and the risks of ischemic stroke or major bleeding events is still unknown.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This is a subanalysis of the RYOUMA registry, a prospective multicenter observational study of Japanese patients who underwent CA for AF in 2017–2018.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Of the 2844 patients, the rate of DOAC continuation was 48.1%, 69.6%, and 80.9% in patients with a CHADS2 score of 0–1, 2, and 3–6, respectively. Among the patients taking DOACs with a CHADS2 score of 0–1 and 2, the incidence rates of major bleeding were significantly higher than those of ischemic stroke or systemic embolic events (SEEs) (1.3%/year [95% CI, 0.6–2.1] vs. 0.3%/year [95% CI, 0.0–0.7], <i>p</i> = 0.019; 1.8%/year [95% CI, 0.6–3.0] vs. 0.2%/year [95% CI, 0.0–0.6], <i>p</i> = 0.018, respectively). However, there was no difference between the incidence rates of major bleeding events and ischemic stroke or SEEs in patients taking DOACs with a CHADS2 score of 3–6 (1.6%/year [95% CI, 0.2–3.0] vs. 1.0%/year [95% CI, 0.0–2.1], <i>p</i> = 0.474).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>In patients with a CHADS2 score of 2, those who continued taking DOACs had a higher incidence rate of major bleeding events compared to ischemic stroke/SEEs, similar to those with a CHADS2 score of 0–1. Conversely, in patients with a CHADS2 score of 3–6, the incidence rates of both ischemic stroke/SEEs and major bleeding were similarly high.</p>\\n \\n <p><b>Trial Registration:</b> The study was registered as UMIN000026092 (University Hospital Medical Information Network-Clinical Trial Registry)</p>\\n </section>\\n </div>\",\"PeriodicalId\":8074,\"journal\":{\"name\":\"Annals of Noninvasive Electrocardiology\",\"volume\":\"30 3\",\"pages\":\"\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-04-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70067\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Noninvasive Electrocardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/anec.70067\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Noninvasive Electrocardiology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/anec.70067","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
房颤（AF）导管消融（CA）后口服抗凝剂（OAC）状态与缺血性卒中或大出血事件风险的关系尚不清楚。RYOUMA登记是一项前瞻性多中心观察性研究，研究对象是2017-2018年因房颤接受CA治疗的日本患者。结果2844例患者中，CHADS2评分为0-1、2和3-6的患者DOAC延续率分别为48.1%、69.6%和80.9%。在CHADS2评分为0-1和2的doac患者中，大出血的发生率显著高于缺血性卒中或全身栓塞事件（SEEs）的发生率(1.3%/年[95% CI， 0.6-2.1] vs. 0.3%/年[95% CI， 0.0-0.7], p = 0.019；1.8% /年(95% CI, 0.6 - -3.0)和0.2% (95% CI, 0.0 - -0.6) /年,分别为p = 0.018)。然而，CHADS2评分为3-6的doac患者的大出血事件和缺血性卒中或see发生率无差异（1.6%/年[95% CI， 0.2-3.0] vs. 1.0%/年[95% CI， 0.0-2.1], p = 0.474）。在CHADS2评分为2的患者中，与缺血性卒中/SEEs相比，继续服用DOACs的患者大出血事件发生率更高，与CHADS2评分为0-1的患者相似。相反，在CHADS2评分为3-6的患者中，缺血性卒中/ see和大出血的发生率同样高。试验注册：研究注册号：UMIN000026092（大学医院医学信息网-临床试验注册）
Assessment of Long-Term Use Versus Discontinuation of Direct Oral Anticoagulant After Catheter Ablation for Atrial Fibrillation—RYOUMA Registry Subanalysis
Background
The relationship between oral anticoagulant (OAC) status after catheter ablation (CA) for atrial fibrillation (AF) and the risks of ischemic stroke or major bleeding events is still unknown.
Methods
This is a subanalysis of the RYOUMA registry, a prospective multicenter observational study of Japanese patients who underwent CA for AF in 2017–2018.
Results
Of the 2844 patients, the rate of DOAC continuation was 48.1%, 69.6%, and 80.9% in patients with a CHADS2 score of 0–1, 2, and 3–6, respectively. Among the patients taking DOACs with a CHADS2 score of 0–1 and 2, the incidence rates of major bleeding were significantly higher than those of ischemic stroke or systemic embolic events (SEEs) (1.3%/year [95% CI, 0.6–2.1] vs. 0.3%/year [95% CI, 0.0–0.7], p = 0.019; 1.8%/year [95% CI, 0.6–3.0] vs. 0.2%/year [95% CI, 0.0–0.6], p = 0.018, respectively). However, there was no difference between the incidence rates of major bleeding events and ischemic stroke or SEEs in patients taking DOACs with a CHADS2 score of 3–6 (1.6%/year [95% CI, 0.2–3.0] vs. 1.0%/year [95% CI, 0.0–2.1], p = 0.474).
Conclusions
In patients with a CHADS2 score of 2, those who continued taking DOACs had a higher incidence rate of major bleeding events compared to ischemic stroke/SEEs, similar to those with a CHADS2 score of 0–1. Conversely, in patients with a CHADS2 score of 3–6, the incidence rates of both ischemic stroke/SEEs and major bleeding were similarly high.
Trial Registration: The study was registered as UMIN000026092 (University Hospital Medical Information Network-Clinical Trial Registry)
期刊介绍：
The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients.
ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation.
ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.
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