JAHA:房颤患者抗凝治疗剂量不当与卒中严重程度和预后的关系

2022-03-04 MedSci原创 MedSci原创

半数患有卒中的房颤患者接受了不适当的OAC治疗。与适当的VKA治疗相比,亚治疗性VKA与更严重的卒中严重程度和更高的死亡率相关。与适当剂量的DOAC相比,在调整后的模型中,剂量不足或过量的DOAC均与

口服抗凝剂(OAC)可有效预防心房颤动患者的卒中。然而,尽管接受了OAC治疗,一些患者仍会发生卒中。

近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,在丹麦卒中登记处(2005-2018年)中确定了首次发生缺血性卒中并接受OAC治疗的房颤患者。

接受维生素K拮抗剂(VKA)治疗的患者根据卒中前的国际标准化比率(国际标准化比率<2[亚治疗]、国际标准化比率2-3[治疗]、国际标准化比率>3[超治疗])进行了比较,并比较了直接OAC(DOAC)治疗剂量不足、治疗剂量适当和过量的患者。研究人员使用斯堪的纳维亚中风量表(0-58分)确定了受试者的卒中严重程度,并通过多变量Logistic回归分析非常严重卒中的风险(0-14分)。研究人员使用多变量Cox回归确定一年死亡率。

该研究共纳入了2319例房颤和卒中患者;1196人正在服用VKA(亚治疗[46%]、治疗[43%]、超治疗[11%]),1123人正在服用DOAC(剂量不足[23%]、适当剂量[60%]和过量[17%])。VKA亚治疗和超治疗(与治疗性相比)和DOAC治疗剂量不足(与适当剂量的DOAC治疗相比)患者年龄较大、女性较多且合并症较多。VKA亚治疗与非常严重的卒中相关(比值比[OR]为2.06[95%CI为1.28-3.31]),而VKA超治疗与非常严重的卒中相关(OR为1.24[95%CI为0.60-2.57])。接受VKA亚治疗和超治疗的患者1年死亡率较高(风险比[HR]为1.66[95%CI为1.29–2.13])。DOAC使用剂量不足或过量与非常严重的卒中无关(OR为1.27[95%CI为0.76–2.15];OR为分别为0.73[95%CI为0.37–1.43]),并且也与1年死亡率(HR为1.09[95%CI为0.83–1.44];HR为0.82[95%CI为0.57–1.18])无关,相比于适当剂量的DOAC治疗。

由此可见,半数患有卒中的房颤患者接受了不适当的OAC治疗。与适当的VKA治疗相比,亚治疗性VKA与更严重的卒中严重程度和更高的死亡率相关。与适当剂量的DOAC相比,在调整后的模型中,剂量不足或过量的DOAC均与更差的结局相关。

原始出处:

Naja E. Vinding.et al.Association Between Inappropriately Dosed Anticoagulation Therapy With Stroke Severity and Outcomes in Patients With Atrial Fibrillation.JAHA.2022.https://www.ahajournals.org/doi/10.1161/JAHA.121.024402

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    2022-03-07 123facfem81(暂无昵称)

    房颤与抗凝

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1200395, encodeId=3c79120039541, content=房颤与抗凝, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ea422452782, createdName=123facfem81(暂无昵称), createdTime=Mon Mar 07 23:30:07 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268782, encodeId=04661268e8213, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Sat Mar 05 13:01:30 CST 2022, time=2022-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614636, encodeId=0119161463691, 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=0, 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=Sat Mar 05 13:01:30 CST 2022, time=2022-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199475, encodeId=466e11994e50d, content=没太读明白, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af2c5726846, createdName=ms3000001643437590, createdTime=Fri Mar 04 21:14:13 CST 2022, time=2022-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199360, encodeId=1e34119936088, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Fri Mar 04 12:30:01 CST 2022, time=2022-03-04, status=1, ipAttribution=)]
    2022-03-05 zhaohui6731
  3. [GetPortalCommentsPageByObjectIdResponse(id=1200395, encodeId=3c79120039541, content=房颤与抗凝, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ea422452782, createdName=123facfem81(暂无昵称), createdTime=Mon Mar 07 23:30:07 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268782, encodeId=04661268e8213, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Sat Mar 05 13:01:30 CST 2022, time=2022-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614636, encodeId=0119161463691, 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=0, 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=Sat Mar 05 13:01:30 CST 2022, time=2022-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199475, encodeId=466e11994e50d, content=没太读明白, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af2c5726846, createdName=ms3000001643437590, createdTime=Fri Mar 04 21:14:13 CST 2022, time=2022-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199360, encodeId=1e34119936088, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Fri Mar 04 12:30:01 CST 2022, time=2022-03-04, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1200395, encodeId=3c79120039541, content=房颤与抗凝, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ea422452782, createdName=123facfem81(暂无昵称), createdTime=Mon Mar 07 23:30:07 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268782, encodeId=04661268e8213, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Sat Mar 05 13:01:30 CST 2022, time=2022-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614636, encodeId=0119161463691, 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=0, 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=Sat Mar 05 13:01:30 CST 2022, time=2022-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199475, encodeId=466e11994e50d, content=没太读明白, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af2c5726846, createdName=ms3000001643437590, createdTime=Fri Mar 04 21:14:13 CST 2022, time=2022-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199360, encodeId=1e34119936088, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Fri Mar 04 12:30:01 CST 2022, time=2022-03-04, status=1, ipAttribution=)]
    2022-03-04 ms3000001643437590

    没太读明白

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1200395, encodeId=3c79120039541, content=房颤与抗凝, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ea422452782, createdName=123facfem81(暂无昵称), createdTime=Mon Mar 07 23:30:07 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268782, encodeId=04661268e8213, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Sat Mar 05 13:01:30 CST 2022, time=2022-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614636, encodeId=0119161463691, 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=0, 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=Sat Mar 05 13:01:30 CST 2022, time=2022-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199475, encodeId=466e11994e50d, content=没太读明白, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af2c5726846, createdName=ms3000001643437590, createdTime=Fri Mar 04 21:14:13 CST 2022, time=2022-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199360, encodeId=1e34119936088, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Fri Mar 04 12:30:01 CST 2022, time=2022-03-04, status=1, ipAttribution=)]
    2022-03-04 yangchou

    好文章,值得一读。

    0

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