Nieuwlaat Robby, Capucci Alessandro, Lip Gregory Y H, Olsson S Bertil, Prins Martin H, Nieman Fred H, López-Sendón José, Vardas Panos E, Aliot Etienne, Santini Massimo, Crijns Harry J G M
Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands.
Eur Heart J. 2006 Dec;27(24):3018-26. doi: 10.1093/eurheartj/ehl015. Epub 2006 May 26.
To describe guideline adherence and application of different stroke risk stratification schemes regarding antithrombotic therapy in real-life atrial fibrillation (AF) patients and to assess which factors influence antithrombotic management decisions.
The Euro Heart Survey enrolled 5333 AF patients in 35 countries, in 2003 and 2004. Prescription of antithrombotic drugs, especially oral anticoagulation (OAC), was hardly tailored to the patient's stroke risk profile as indicated by the joint guidelines of the American College of Cardiology, American Heart Association, and the European Society of Cardiology, ACCP guidelines, or CHADS(2) and Framingham risk scores. In multivariable analysis, only a limited number of the well-known stroke risk factors triggered OAC prescription. In contrast, less relevant factors, of which clinical type of AF and availability of an OAC monitoring outpatient clinic were the most marked, played a significant role in OAC prescription. Electrical cardioversions and catheter ablations clearly triggered OAC prescription, whereas pharmacological cardioversions even in the presence of stroke risk factors did not.
Antithrombotic therapy in AF is hardly tailored to the patient's stroke risk profile. Factors other than well-known stroke risk factors were significantly involved in antithrombotic management decisions. To facilitate this tailored treatment, guideline writers and physician educators should focus on providing one uniform and easy to use stroke risk stratification scheme.
描述在现实生活中的心房颤动（AF）患者中，不同卒中风险分层方案在抗栓治疗方面的指南依从性及应用情况，并评估哪些因素会影响抗栓治疗管理决策。
欧洲心脏调查在2003年和2004年纳入了35个国家的5333例AF患者。抗栓药物的处方，尤其是口服抗凝药（OAC），几乎没有根据美国心脏病学会、美国心脏协会和欧洲心脏病学会的联合指南、美国胸科医师学会（ACCP）指南或CHADS（2）及弗雷明汉风险评分所指示的患者卒中风险状况进行调整。在多变量分析中，只有少数众所周知的卒中危险因素会促使开具OAC处方。相比之下，不太相关的因素，其中最显著的是AF的临床类型和是否有OAC监测门诊，在OAC处方中起了重要作用。电复律和导管消融明显促使开具OAC处方，而即使存在卒中危险因素，药物复律也不会。
AF患者的抗栓治疗几乎没有根据患者的卒中风险状况进行调整。除了众所周知的卒中危险因素外，其他因素也显著参与了抗栓治疗管理决策。为了促进这种个性化治疗，指南编写者和医生教育工作者应专注于提供一种统一且易于使用的卒中风险分层方案。
