Yonsei University Health System, Seoul, Republic of Korea.
J Cardiovasc Electrophysiol. 2010 May;21(5):501-7. doi: 10.1111/j.1540-8167.2009.01661.x. Epub 2009 Dec 15.
The revised ACC/AHA/ESC 2006 guideline recommends either aspirin or warfarin for the prevention of ischemic stroke in patients with atrial fibrillation (AF) in CHADS(2) score 1. We hypothesized that warfarin is superior to aspirin therapy for the prevention of stroke without increasing bleeding complication in AF patients with CHADS(2) score 1.
Among 1,502 patients (mean 62.4 +/- 13.8 years old, male 65.4%) who were treated for nonvalvular AF without previous stroke, the number of patients with CHADS(2) score 1 was 422 (62.9 +/- 10.7 years old, male 290 [68.7%]) and their antithrombotic therapies were as follows: warfarin (n = 143), aspirin (n = 124), other antiplatelet (n = 45), and no antithrombosis (none: n = 110). We reviewed the incidences of ischemic stroke, mortality, and bleeding complications during the follow-up period. Results were: (1) during 22.3 +/- 17.8 months of follow-up, the incidence of ischemic stroke was significantly lower in warfarin (6 patients, 4.2%, mean international normalized ratio [INR] 2.0 +/- 0.5 IU) than in aspirin (16 patients, 12.9%, P = 0.008) than none (23 patients, 20.9%, P < 0.001) without differences in all-cause mortality. (2) The incidence of major bleeding (decrease in hemoglobin >or=2 g/dL, requiring hospitalization or red blood cell transfusion >or=2 pints) was not different between warfarin (2.1%) and aspirin (0.8%, P = NS), but minor bleeding was more common in warfarin (10.5%) than in aspirin (2.4%, P = 0.007).
In AF patients with CHADS(2) score 1, warfarin was better to prevent ischemic stroke than aspirin without increasing the incidence of major bleeding complications. However, the incidence of minor bleeding was higher in the warfarin group than the aspirin group.
修订后的 ACC/AHA/ESC 2006 指南建议 CHADS(2)评分为 1 的心房颤动（AF）患者，应用阿司匹林或华法林预防缺血性脑卒中。我们假设，与阿司匹林治疗相比，华法林在预防 CHADS(2)评分为 1 的 AF 患者的脑卒中方面更具优势，同时不增加出血并发症。
在 1502 例（平均年龄 62.4±13.8 岁，男性 65.4%）无先前脑卒中的非瓣膜性 AF 患者中，CHADS(2)评分为 1 的患者有 422 例（62.9±10.7 岁，男性 290 例[68.7%]），他们的抗血栓治疗如下：华法林（n=143）、阿司匹林（n=124）、其他抗血小板药物（n=45）和无抗血栓治疗（n=110）。我们随访了这些患者的缺血性脑卒中、死亡率和出血并发症的发生情况。结果如下：（1）在 22.3±17.8 个月的随访期间，华法林组（6 例，4.2%，平均 INR 2.0±0.5IU）缺血性脑卒中的发生率明显低于阿司匹林组（16 例，12.9%，P=0.008）和无抗血栓治疗组（23 例，20.9%，P<0.001），但全因死亡率无差异。（2）华法林组（2.1%）和阿司匹林组（0.8%）的大出血（血红蛋白下降≥2g/dL，需住院或输红细胞≥2 单位）发生率无差异（P=NS），但华法林组的轻微出血更为常见（10.5%），而阿司匹林组（2.4%）则较少（P=0.007）。
在 CHADS(2)评分为 1 的 AF 患者中，与阿司匹林相比，华法林预防缺血性脑卒中更有效，且不增加主要出血并发症的发生率。然而，华法林组的轻微出血发生率高于阿司匹林组。
