Service de Cardiologie, Pôle Coeur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
Thromb Haemost. 2010 Apr;103(4):833-40. doi: 10.1160/TH09-10-0746. Epub 2010 Feb 2.
In patients with atrial fibrillation (AF) and an intermediate risk of stroke (CHADS2 score =1), available evidence from clinical trials is inconclusive and the present guidelines for the management of AF indicate that the choice between oral anticoagulant and aspirin in these patients is open. Our goal was to evaluate whether, in patients with AF and only one moderate risk factor for thromboembolism, treatment with an oral anticoagulant is appreciably more beneficial than treatment with an antiplatelet agent. Among 6,517 unselected patients with AF, 1,012 of them (15.5%) had a CHADS2 score of 1 and were liable to treatment with an antiplatelet agent or an anticoagulant. An oral anticoagulant was prescribed for 606 patients (59.9%) and an antiplatelet agent or no antithrombotic treatment for 406 (40.1%). During follow-up (median=793 days, interquartile range=1,332 days), 105 deaths (10.4%) and 19 strokes (1.9%) were recorded. The administration of an anticoagulant was associated with a lower rate of events (relative risk=0.42, 95% confidence interval 0.29-0.60, p<0.0001) than when no anticoagulant was prescribed. Results remained similar after adjustment for age and other confounding factors. In contrast, prescription of an antiplatelet agent was not associated with a lower risk of events. Factors independently associated with an increased risk of events were older age (p<0.0001), concomitant heart failure (p=0.0002), diabetes (p=0.0025), lack of prescription of an anticoagulant (p<0.0001) and permanent AF (p=0.04). Thus, prescription of an anticoagulant is independently associated with a decreased risk of death or stroke among patients with AF and a CHADS2 score =1.
在心房颤动（AF）和中风中危风险（CHADS2 评分=1）的患者中，临床试验的现有证据尚无定论，目前 AF 管理指南表明，这些患者中口服抗凝剂与阿司匹林之间的选择是开放的。我们的目标是评估在仅有一个中等血栓栓塞风险因素的 AF 患者中，口服抗凝剂治疗是否明显优于抗血小板治疗。在 6517 例未选择的 AF 患者中，有 1012 例（15.5%）CHADS2 评分为 1，需要接受抗血小板或抗凝治疗。为 606 例患者（59.9%）开具了口服抗凝剂处方，为 406 例患者（40.1%）开具了抗血小板药物或未进行抗血栓治疗。在随访期间（中位数=793 天，四分位距=1332 天），记录了 105 例死亡（10.4%）和 19 例中风（1.9%）。与未开具抗凝药相比，给予抗凝剂的事件发生率较低（相对风险=0.42，95%置信区间 0.29-0.60，p<0.0001）。调整年龄和其他混杂因素后，结果仍然相似。相比之下，开具抗血小板药物与降低事件风险无关。与事件风险增加独立相关的因素是年龄较大（p<0.0001）、心力衰竭并存（p=0.0002）、糖尿病（p=0.0025）、未开具抗凝剂（p<0.0001）和永久性 AF（p=0.04）。因此，在 CHADS2 评分为 1 的 AF 患者中，开具抗凝剂与降低死亡或中风风险独立相关。
