Mayo Clin Proc:AF患者遵照指南抗血栓好处多多!

2017-08-31 吴星 环球医学

抗血栓治疗可以预防房颤患者发生卒中。2017年8月,发表在《Mayo Clin Proc》的一项基于社区的Darlington注册队列研究表明,遵照指南进行抗血栓治疗能够显著降低卒中风险,改善生存。



血栓治疗可以预防房颤患者发生卒中。2017年8月,发表在《Mayo Clin Proc》的一项基于社区的Darlington注册队列研究表明,遵照指南进行抗血栓治疗能够显着降低卒中风险,改善生存。

目的:评价依从于指南与不依从于指南的抗血栓治疗(ATT)相比,对房颤(AF)一级治疗人群卒中和死亡率的影响。

受试者和方法:研究者使用2012年3月31日至2013年3月31日期间,纳入105000例患者的Darlington注册队列。根据2014年英国国家卫生研究院和护理卓越(NICE)指南,其推荐除非卒中的风险真的很低(男性CHA2DS2-VASc=0 ;女性CHA2DS2-VASc=1)否则默认需口服抗凝药预防卒中,对ATT指南的依从性进行评价。

结果:在2259例(2.15%)AF患者中,36.1%治疗不足,50.8%具有指南依从性,13.1%过度治疗。口服抗凝药降低5.0%,8.3%为不当治疗。在67例卒中突发(3.0%)病例中,66例(98.5%)为高风险患者(CHA2DS2-VASc≥2)。对于高风险队列,治疗不足患者的1年卒中率为4.5%(95% CI,3.2%~6.3%),具有指南依从性的患者1年卒中率为1.9%(95% CI,1.2%~2.9%),过度治疗的患者1年卒中率为7.2%(95% CI,4.4%~11.6%),相应的死亡率分别为16.1%(95% CI,13.6%~19.0%)、8.0%(95% CI,6.5%~9.8%)和8.2%(95% CI,5.2%~12.7%)。多变量分析显示,高风险患者治疗不足和过度治疗与卒中率显着升高相关(分别为比值比 [OR]=2.32;95% CI,1.30~3.14;P=0.005和 OR=2.28; 95% CI,1.12~4.63;P=0.02)。治疗不足与全因死亡率显着增加相关(OR=1.59;95% CI,1.14~2.21;P=0.006)。

结论:仅有半数符合治疗标准的AF患者获得依据指南推荐的口服抗凝药处方。依从于指南的ATT可显着降低卒中风险,改善生存。

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    2017-11-27 zhmscau
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    2018-08-08 linlin2312
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    2017-09-02 大爰

    学习了谢谢分享!!

    0

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    2017-09-02 gwc388
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    2017-09-02 sunylz
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    2017-09-01 龙胆草

    学习谢谢分享

    0

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    2017-08-31 楠博One

    学习谢谢分享

    0

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    2017-08-31 1e10c84am36(暂无匿称)

    文章很好.值得分享

    0

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    2017-08-31 有备才能无患

    抗血栓治疗可以预防房颤患者发生卒中.2017年8月.发表在的一项基于社区的Darlington注册队列研究表明.遵照指南进行抗血栓治疗能够显着降低卒中风险.改善生存.

    0

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