Ruiz Ortiz Martín, Romo Elías, Mesa Dolores, Delgado Mónica, Anguita Manuel, Castillo Juan C, Arizón José M, Suárez de Lezo José
Cardiology Department, Hospital Reina Sofía, Cordoba, Spain.
Cardiology. 2010;115(3):200-4. doi: 10.1159/000284450. Epub 2010 Feb 17.
CHADS(2) score predicts embolic risk in patients with nonvalvular atrial fibrillation (NVAF), but also bleeding risk in patients receiving oral anticoagulation (OAC). Our objective is to analyze the effectiveness and safety of OAC in patients with NVAF in daily clinical practice, according to embolic risk evaluated by means of CHADS(2) score.
All consecutive outpatients with permanent NVAF seen at 2 cardiology clinics were prospectively followed for embolic events (transient ischemic attack, ischemic stroke, peripheral embolism) and severe bleedings. OAC was prescribed according to the recommendations of scientific associations. CHADS(2) score was obtained for each patient.
From February 1, 2000 to July 31, 2003, 796 outpatients fulfilled the inclusion criteria. OAC was prescribed to 564 (71%) patients. After 2.4 +/- 1.9 years of follow-up, the embolic event rates (per 100 patient-years) for each stratum of the CHADS(2 )score for patients with/without OAC were: 1/4.1, p = 0.23 (CHADS(2) = 0); 0.6/7.1, p = 0.0018 (CHADS(2) = 1); 0.5/5.1, p = 0.0014 (CHADS(2) = 2); 2.4/12.5, p = 0.0017 (CHADS(2) = 3) and 2.9/20, p = 0.013 (CHADS(2) >or=4). The severe bleeding rates for the same CHADS(2) score strata were 3/0.8, 0.8/0.7, 1.3/0.7, 0.4/0, and 2.9/5 in patients with/without OAC (n.s.).
OAC is effective and safe in daily clinical practice in patients with NVAF and CHADS(2) score >or=1.
CHADS(2)评分可预测非瓣膜性心房颤动（NVAF）患者的栓塞风险，但也能预测接受口服抗凝药（OAC）治疗患者的出血风险。我们的目的是根据通过CHADS(2)评分评估的栓塞风险，分析日常临床实践中OAC治疗NVAF患者的有效性和安全性。
前瞻性随访两家心脏病诊所连续就诊的所有永久性NVAF门诊患者的栓塞事件（短暂性脑缺血发作、缺血性卒中、外周栓塞）和严重出血情况。根据科学协会的建议开具OAC。为每位患者计算CHADS(2)评分。
2000年2月1日至2003年7月31日，796例门诊患者符合纳入标准。564例（71%）患者接受了OAC治疗。经过2.4±1.9年的随访，使用/未使用OAC的患者中，CHADS(2)评分各分层的栓塞事件发生率（每100患者年）分别为：1/4.1，p = 0.23（CHADS(2)=0）；0.6/7.1，p = 0.0018（CHADS(2)=1）；0.5/5.1，p = 0.0014（CHADS(2)=2）；2.4/12.5，p = 0.0017（CHADS(2)=3）和2.9/20，p = 0.013（CHADS(2)≥4）。相同CHADS(2)评分分层的严重出血发生率在使用/未使用OAC的患者中分别为3/0.8、0.8/0.7、1.3/0.7、0.4/0和2.9/5（无显著性差异）。
在日常临床实践中，OAC治疗CHADS(2)评分≥1的NVAF患者有效且安全。
