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JACC：强化抗栓不改善房颤患者预后？

2014-05-09 高晓方 译 医学论坛网

强化抗栓治疗房颤患者
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美国一项研究表明，在同时伴有心衰和血管疾病的房颤患者中，于维生素K拮抗剂(VKA)治疗基础上添加抗血小板药物未能降低血栓栓塞或冠脉风险，反而会升高出血风险。论文于4月30日在线发表于《美国心脏病学会杂志》(J Am Coll Cardiol)。此项研究共纳入37464例伴有冠脉疾病或外周动脉疾病等血管疾病的心衰住院患者，平均年龄为74.5岁，女性36.3%。将房颤状况分类为泛发、偶发和无房颤。以抗

美国一项研究表明，在同时伴有心衰和血管疾病的房颤患者中，于维生素K拮抗剂(VKA)治疗基础上添加抗血小板药物未能降低血栓栓塞或冠脉风险，反而会升高出血风险。论文于4月30日在线发表于《美国心脏病学会杂志》(J Am Coll Cardiol)。

此项研究共纳入37464例伴有冠脉疾病或外周动脉疾病等血管疾病的心衰住院患者，平均年龄为74.5岁，女性36.3%。将房颤状况分类为泛发、偶发和无房颤。以抗血栓治疗和房颤为时间依赖变量，利用Cox回归模型对血栓栓塞、心梗和严重出血风险进行评估。平均随访时间为3年。

结果显示，随访期间分别有20.7%和17.2%的患者被分类为泛发和偶发房颤。在泛发房颤患者中，与VKA相比，VKA联合抗血小板药与血栓栓塞或心梗风险降低无相关性(HR 0.91)，但与出血风险显著升高相关(HR 1.31)。在无房颤患者中，抗血栓治疗对血栓栓塞或心梗风险无统计学影响，但伴或不伴单药抗血小板治疗的VKA可显著升高出血风险。

原始出处：


Lamberts M1, Lip GY2, Ruwald MH3, Hansen ML3, Ozcan C3, Kristensen SL3, Køber L4, Torp-Pedersen C5, Gislason GH6.Antithrombotic treatment in patients with heart failure and associated atrial fibrillation and vascular disease: A nationwide cohort study.J Am Coll Cardiol. 2014 Apr 16. pii: S0735-1097(14)02048-8. doi: 10.1016/j.jacc.2014.03.039. [Epub ahead of print]

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    2015-02-16 hbwxf

    #JACC#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1853281, encodeId=3e4c1853281bf, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Feb 16 08:15:00 CST 2015, time=2015-02-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691830, encodeId=fb511691830ec, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Tue Apr 21 13:15:00 CST 2015, time=2015-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1324932, encodeId=1dc0132493237, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sun May 11 09:15:00 CST 2014, time=2014-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614246, encodeId=f7e0161424650, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sun May 11 09:15:00 CST 2014, time=2014-05-11, status=1, ipAttribution=)]
    2015-04-21 bnurmamat

    #患者预后#

    0

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    2014-05-11 12498568m50暂无昵称

    #ACC#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1853281, encodeId=3e4c1853281bf, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Feb 16 08:15:00 CST 2015, time=2015-02-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691830, encodeId=fb511691830ec, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Tue Apr 21 13:15:00 CST 2015, time=2015-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1324932, encodeId=1dc0132493237, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sun May 11 09:15:00 CST 2014, time=2014-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614246, encodeId=f7e0161424650, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sun May 11 09:15:00 CST 2014, time=2014-05-11, status=1, ipAttribution=)]
    2014-05-11 hittouch

    #房颤患者#

    0