Stroke:采用非维生素K拮抗剂口服抗凝药预防卒中的房颤患者脑出血危险因素分析

2021-03-05 MedSci原创 MedSci原创

一些危险因素与服用NOAC预防卒中的患者ICH发生相关,但HAS-BLED和CHA2DS2-VASc得分与其无关。

房颤患者卒中预防的临床试验结果一致表明,服用华法林或非维生素K拮抗剂口服抗凝剂(NOAC)可以获得临床益处。一直以来,NOAC治疗的患者发生脑出血(ICH)的风险比华法林治疗的患者要低。

近日,血管疾病领域权威杂志Stroke上发表了一篇研究文章,这项前瞻性、多中心、跨国、未匹配的病例对照研究旨在(1)探究可预测NOAC治疗期间房颤患者发生ICH的危险因素,以及(2)评估CHA2DS2-VASc和HAS-BLED的作用。

该研究的病例为连续就诊的房颤患者,这些患者在NOAC治疗期间发生ICH。对照组为连续就诊的房颤患者,他们在NOAC治疗期间未发生ICH。由于在CHA2DS2-VASc和HAS-BLED评分中存在一些共同的危险因素,因此,研究人员使用了几个多变量Logistic回归模型来确定ICH事件的独立预测因素。

该研究纳入了419例(平均年龄为78.8±8.1岁)患者和1526名对照者(平均年龄为76.0±10.3岁)。从不同模型中,ICH的独立预测因素包括年龄增长、同时使用抗血小板药、活动性恶性肿瘤、跌倒高风险、高脂血症、低肌酐清除率、外周动脉疾病和白质改变。低剂量NOAC和充血性心力衰竭与ICH的发生风险呈负相关。HAS-BLED和CHA2DS2-VASc评分在预测ICH方面表现较差,曲线下面积分别为0.496(95%CI为0.468-0.525)和0.530(95%CI为0.500-0.560)。

由此可见,一些危险因素与服用NOAC预防卒中的患者ICH发生相关,但HAS-BLED和CHA2DS2-VASc得分与其无关

原始出处:

Maurizio Paciaroni.et al.Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention.stroke.2021.https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.031827

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    2022-05-04 maotouying

    学习了

    0

  2. 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    2021-07-14 1489ebc8m64暂无昵称

    good

    0

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  4. 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  5. 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  6. 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  7. 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  8. 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  9. 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GetPortalCommentsPageByObjectIdResponse(id=1026782, encodeId=57771026e82f7, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Mar 05 15:26:31 CST 2021, time=2021-03-05, status=1, ipAttribution=)]
    2021-03-05 筱沐

    #学习#学习了

    0

  10. 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    2021-03-05 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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