Parkash Ratika, Wee Vinnie, Gardner Martin J, Cox Jafna L, Thompson Kara, Brownell Brenda, Anderson David R
Department of Medicine, Dalhousie University and Capital Health, Halifax, Canada.
Can J Cardiol. 2007 May 1;23(6):457-61. doi: 10.1016/s0828-282x(07)70784-5.
Atrial fibrillation (AF) is the most common adult arrhythmia, and significantly increases the risk of ischemic stroke. Oral anticoagulation may be underused and may be less effective in community settings than clinical trial settings.
To determine the rates of thromboembolism and bleeding in an ambulatory cohort of patients with AF.
Observational study of Nova Scotian residents with AF identified by electrocardiogram in ambulatory settings between November 1999 and January 2001. Main outcome measures were rates of thromboembolism and bleeding over two years.
Four hundred twenty-five patients were included in the study. The mean (+/-SD) age was 70.6+/-11.1 years, and 40% were women. Warfarin therapy was used by 68% of patients. Sixty-two per cent of patients had hypertension, 21% had a previous stroke or transient ischemic attack, 44% had congestive heart failure and 20% were diabetic. The overall rate of thromboembolic events was 2.7% in warfarin users and 8.5% in nonwarfarin users over two years, with an RR reduction of 68% (OR 0.31, 95% CI 0.09 to 0.91; P=0.047). The annual rate of ischemic stroke was 1.2% and 3.1% in warfarin and nonwarfarin users, respectively, with an RR reduction of 62% (OR 0.29, 95% CI 0.08 to 1.04; P=0.057). The overall rate of major bleeding was 2.6% in warfarin users and 1.4% in nonwarfarin users (P=0.667). The annual mortality rate was 7.79% in warfarin users and 9.93% in nonwarfarin users (P=0.192).
Warfarin use was found to significantly reduce the rate of thromboembolic events without a concomitant increase in hemorrhagic events. The present study confirms the effectiveness of warfarin therapy in a population-based cohort.
心房颤动（AF）是最常见的成人心律失常，会显著增加缺血性中风的风险。口服抗凝治疗的应用可能不足，且在社区环境中的效果可能不如临床试验环境。
确定非卧床AF患者队列中的血栓栓塞和出血发生率。
对1999年11月至2001年1月在非卧床环境中通过心电图确诊的新斯科舍省AF居民进行观察性研究。主要结局指标是两年内的血栓栓塞和出血发生率。
425例患者纳入研究。平均（±标准差）年龄为70.6±11.1岁，40%为女性。68%的患者使用华法林治疗。62%的患者患有高血压，21%曾有中风或短暂性脑缺血发作，44%患有充血性心力衰竭，20%患有糖尿病。两年内，华法林使用者的血栓栓塞事件总发生率为2.7%，非华法林使用者为8.5%，相对危险度降低68%（比值比0.31，95%可信区间0.09至0.91；P = 0.047）。华法林使用者和非华法林使用者的缺血性中风年发生率分别为1.2%和3.1%，相对危险度降低62%（比值比0.29，95%可信区间0.08至1.04；P = 0.057）。华法林使用者的大出血总发生率为2.6%，非华法林使用者为1.4%（P = 0.667）。华法林使用者的年死亡率为7.79%，非华法林使用者为9.93%（P = 0.192）。
发现使用华法林可显著降低血栓栓塞事件的发生率，且不会同时增加出血事件。本研究证实了华法林治疗在基于人群的队列中的有效性。
