Circulation:口服抗凝药物对于有颅内出血史的房颤患者是否有益?

2016-03-15 崔倩 译 MedSci原创

有颅内出血(ICH)史的房颤(AF)患者通过口服抗凝剂进一步患ICH的风险和降低卒中的效果目前仍不清楚。该研究的目的是调查通过华法林和抗血小板药物治疗过IHC的AF患者,与那些没有经过抗血栓治疗的患者相比的风险和益处。本研究采用了台湾“国民健康保险研究数据库”。在CHA2DS2-VASc评分≥2的307640例AF患者中,12,917例ICH患者病史被确定,并且被分成3组,即,不治疗,抗血小板治疗

有颅内出血(ICH)史的房颤(AF)患者通过口服抗凝剂进一步患ICH的风险和降低卒中的效果目前仍不清楚。该研究的目的是调查通过华法林和抗血小板药物治疗过IHC的AF患者,与那些没有经过抗血栓治疗的患者相比的风险和益处。

本研究采用了台湾“国民健康保险研究数据库”。在CHA2DS2-VASc评分≥2的307640例AF患者中,12,917例ICH患者病史被确定,并且被分成3组,即不治疗、抗血小板治疗和华法林治疗组。在原先患过ICH患者中,未经治疗的患者ICH和缺血性卒中发生率分别为每100人-年4.2例和5.8例。华法林使用者每年ICH和缺血性卒中率分别为5.9%和3.4%。在抗血小板药物的使用者中,这些概率分别为5.3%/年和5.2%/年。对于CHA2DS2-VASC评分≥6使用华法林的患者,为防止缺血性脑卒中的需要治疗的人数(NNT)比患IHC需受伤害人数(NNH)低(37 vs 56)。CHA2DS2-VASC评分<6的患者NNT比NNH高(63 vs 53)。

对于CHA2DS2-VASC评分≥6且之前患ICH的AF患者,华法林的使用可能是有利的。非维生素K拮抗剂口服抗凝血剂(NOACs)是否可以降低治疗阈值还需要进一步研究证明。

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    2016-03-22 1de304d2m86(暂无匿称)

    值得学习

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    2016-03-16 任然

    华法林不错的

    0

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