Circulation:需口服抗凝的房颤负荷阈值和中风风险

2019-06-03 QQ MedSci原创

房颤(AF)与中风风险增加有关;但尚无明确的开始口服抗凝(OAC)的AF负荷阈值。现研究人员尝试研究OAC处方实践的变化与新发房颤预后的关系。研究人员开展一回顾性队列研究,纳入心脏植入电子设备、与2011年-2014年进行远程监测、CHA2DS20VASc评分≥2,而且无中风史的患者或在过去2年口服抗凝的患者。在10212位心脏植入电子设备的患者中,其中4570(45%)、3969(39%)、32

房颤(AF)与中风风险增加有关;但尚无明确的开始口服抗凝(OAC)的AF负荷阈值。现研究人员尝试研究OAC处方实践的变化与新发房颤预后的关系。

研究人员开展一回顾性队列研究,纳入心脏植入电子设备、与2011年-2014年进行远程监测、CHA2DS20VASc评分≥2,而且无中风史的患者或在过去2年口服抗凝的患者。

在10212位心脏植入电子设备的患者中,其中4570(45%)、3969(39%)、3263(32%)和2469(24%)位患者设备检测到的AF持续发作时间分别为>6min、>1h、>6h和>24h。对于AF房颤发作持续1h以上的患者,其中1712位符合纳入标准(72±10岁、1.5% 女性、CHA2DS20VASc评分4.0±1.4、HAS-BLED评分 2.6±1.1)。根据AF发作持续时间的不同,接受OAC的患者比例也有所不同(≥6min:272/2101 [13%]; >1h: 273/1712 [16%]; >6h: 263/1279 [21%]; >24h: 224/818 [27%])。对于52个地点的1329位患者,检测到AF发作持续1h以上后予以OAC治疗的患者比例,不同地点之间有一定差异(中位值 16%;3%-67%;中位优势比 1.56[95% CI 1.49-1.71])。在校正模型中,AF发作持续24h以上予以OAC治疗可降低中风风险(风险比 0.28,95% CI 0.10-0.81,P=0.02)。

对于心脏植入电子设备的患者,房颤很常见。检测到房颤后,进行OAC治疗的患者比例有所差异,总体上治疗比例较低,即使房颤发作持续超过24h。房颤发作持续超过24h,OAC治疗可明显降低中风风险。可进行随机试验来进一步验证该结果。

原始出处:

Alexander C. Perino, et al. Practice Variation in Anticoagulation Prescription and Outcomes After Device-Detected Atrial Fibrillation. Circulation. 28 May 2019. https://doi.org/10.1161/CIRCULATIONAHA.118.038988. 2019;139:2502–2512

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1739707, encodeId=f6c41e397075a, content=<a href='/topic/show?id=ff0c2262459' target=_blank style='color:#2F92EE;'>#中风风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22624, encryptionId=ff0c2262459, topicName=中风风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c9ba34554146, createdName=1249898am26暂无昵称, createdTime=Mon Jul 01 00:47:00 CST 2019, time=2019-07-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553608, encodeId=13cf1553608fe, content=<a href='/topic/show?id=839e9e33475' target=_blank style='color:#2F92EE;'>#阈值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97334, encryptionId=839e9e33475, topicName=阈值)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2f4f14387940, createdName=qjddjq, createdTime=Wed Jun 05 09:47:00 CST 2019, time=2019-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=367280, encodeId=045436e2809f, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Tue Jun 04 20:40:02 CST 2019, time=2019-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1045866, encodeId=b32f104586614, content=中风是俗称,应该称为缺血性卒中吧, 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=guging, createdTime=Mon Jun 03 21:47:00 CST 2019, time=2019-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=367226, encodeId=710136e22682, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Mon Jun 03 19:26:44 CST 2019, time=2019-06-03, status=1, ipAttribution=)]
    2019-06-05 qjddjq
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    2019-06-04 329523732

    不错

    0

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    2019-06-03 guging

    中风是俗称,应该称为缺血性卒中吧

    0

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    2019-06-03 329523732

    不错

    0

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