应用 CHADS2 风险评分指导房颤患者抗栓治疗——仍有改进空间。

Use of the CHADS2 risk score to guide antithrombotic treatment in patients with atrial fibrillation--room for improvement.

机构信息

Department of Cardiology, University Hospital Basel, Basel, Switzerland.

出版信息

Swiss Med Wkly. 2010 Feb 6;140(5-6):73-7. doi: 10.4414/smw.2010.12943.

DOI:10.4414/smw.2010.12943

PMID:19950036

Abstract

BACKGROUND

Antithrombotic treatment (AT) is recommended for patients with atrial fibrillation (AF), except for those with lone AF or contraindications.

AIM

The aim of our study was to determine contemporary AT in AF patients and to ascertain reasons for withholding oral anticoagulant treatment (OAC) in eligible patients.

DESIGN

Prospective observational study.

METHODS

Consecutive patients were screened for non-valvular paroxysmal or permanent AF. Subjects with newly diagnosed AF or with an indication for AT other than AF were excluded. According to the CHADS2 risk score patients were divided into a low- (CHADS2 = 0), an intermediate (CHADS2 = 1) and a high risk group (CHADS2 > or =2). AT on hospital admission was correlated to current guidelines.

RESULTS

389 patients were screened and 84 (22%) excluded (71 new onset AF, 13 other indications for OAC). Of the remaining 305 patients (80 +/- 10 yrs) 43% had paroxysmal and 57% permanent AF. Eleven patients (4%) were classified as low risk, 61 (20%) as intermediate risk, and 233 (76%) as high risk. In patients at low risk OAC was prescribed in 63%, whereas one third of those at high risk were not on anticoagulant therapy. The main reasons why OAC was withheld in high risk patients were presumed risk of fall in 21 patients (27%), while the grounds were a history of major bleeding and presumed drug non-compliance in 13 (17%), respectively.

CONCLUSION

In this survey of AF-patients, AT was not tailored to the thromboembolic risk.

摘要

背景

除了孤立性房颤或有禁忌症的患者，推荐对房颤（AF）患者进行抗血栓治疗（AT）。

目的

我们的研究目的是确定 AF 患者的当代 AT，并确定有资格接受口服抗凝治疗（OAC）的患者中不使用 OAC 的原因。

设计

前瞻性观察性研究。

方法

连续筛查非瓣膜性阵发性或永久性 AF 患者。排除新诊断为 AF 或有 AT 指征而非 AF 的患者。根据 CHADS2 风险评分，患者分为低危（CHADS2=0）、中危（CHADS2=1）和高危组（CHADS2≥2）。入院时的 AT 与现行指南相关联。

结果

共筛查 389 例患者，排除 84 例（71 例新发 AF，13 例 OAC 其他指征）。剩余的 305 例患者（80±10 岁）中，43%为阵发性，57%为永久性 AF。11 例（4%）为低危，61 例（20%）为中危，233 例（76%）为高危。低危患者中 OAC 处方率为 63%，而高危患者中有三分之一未接受抗凝治疗。高危患者中不使用 OAC 的主要原因是有 21 例（27%）推测有跌倒风险，有 13 例（17%）分别有大出血史和推测药物不依从史。