Abstract:

Objective

To evaluate the efficacy and safety of different anticoagulation strategies after one-stop surgery in patients with non-valvular atrial fibrillation (AF).

Methods

Patients who underwent one-stop surgery for AF at The first Affiliated Hospital of Xinjiang Medical University from April 2018 to October 2021 were included consecutive. Demographic data such as age and sex, type of AF, liver and renal function, echocardiographic parameters, previous comorbidities and oral anticoagulants of patients were collected. The postoperative period was divided into a group of patients taking novel oral anticoagulants in combination with antiplatelet agents (combined group) and a group taking novel oral anticoagulants alone (anticoagulation group), depending on the different anticoagulation strategies they received. Patients were followed up regularly to collect information on all-cause mortality, major bleeding, any stroke,thromboembolism and device-related thrombosis (DRT), occluder dislodgement and residual shunt ＞5 mm. The safety end point was defined as all-cause death and major bleeding; the effectiveness end point was defined as any stroke, thromboembolism and DRT, and the composite end point was defined as all-cause death, major bleeding, stroke, thromboembolism and DRT.

Results

A total of 126 individuals were included, 63.5% (80/126) were male, with a median age of 68.5 (61.3, 76.0) years, a CHA₂DS₂-VASc score of 4 (3, 5) and a HAS-BLED score of 2 (1, 3). There were 73 patients in the combined group and 53 patients in the anticoagulation group. Median follow-up was 10 (6, 16) months. In the combined group, there were 2 (2.7%, 2/73) major haemorrhagic events, 1 (1.4%, 1/73) lower limb deep vein thrombosis, 1 (1.4%, 1/73) death, and 15(20.5%, 15/73) recurrences. In the anticoagulation group, there were 1 (1.9%, 1/53) lower limb deep vein thrombosis and 9 (17%, 9/53) recurrences occurred. No events such as stroke, blocker dislodgement, DRT, or residual shunt ＞5 mm occurred in either group. There was no statistically significant difference between the two groups in terms of safety and efficacy endpoint events (P＞0.05). The difference in survival analysis of the composite endpoint between the two groups was not statistically significant (Log-rank P = 0.285).

Conclusion

Novel oral anticoagulants alone are as safe and effective as a combination of novel oral anticoagulants combined with antiplatelet agents in patients with AF after one-stop surgery.

Key words: Atrial fibrillation, Catheter ablation, Left atrial appendage closure, One-stop, Anticoagulation