Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Can J Cardiol. 2013 Oct;29(10):1173-80. doi: 10.1016/j.cjca.2013.06.001. Epub 2013 Aug 7.
Our approach to managing patients with atrial fibrillation has changed substantially over the past 10 years, as a result of numerous high-quality observation studies and randomized trials. In this article, we will provide practical guidance for the use of oral anticoagulation therapy in patients with atrial fibrillation. We will review the evolution of stroke and bleeding risk prediction schemes and discuss their role in patient care. Initially, stroke prediction schemes were used to identify patients with atrial fibrillation at the highest risk of stroke, in whom the use of oral anticoagulant therapy was believed to be the most important. However; with the advent of new, safer, and more convenient oral anticoagulant drugs, the role of these schemes has shifted to the identification of the lowest risk patients, representing the minority of patients with atrial fibrillation, in whom oral anticoagulant therapy is not recommended. At the same time, schemes were developed to predict bleeding, the major risk of oral anticoagulant therapy. However; use of these schemes has been limited by their complexity and significant correlation with stroke schemes. In general, it is advisable to base the decision to use oral anticoagulation on the patient's stroke risk and use bleeding schemes to identify absolute contraindications or modifiable risk factors for bleeding. Prediction schemes have been useful clinical tools, invaluable in the design of clinical trials, and have assisted greatly in economic analyses. However, the nature and role of such schemes is now adapting to the current era of novel oral anticoagulant agents.
在过去的 10 年中，由于大量高质量的观察性研究和随机试验，我们管理心房颤动患者的方法发生了重大变化。在本文中，我们将为心房颤动患者使用口服抗凝治疗提供实用指南。我们将回顾卒中风险和出血风险预测方案的演变，并讨论它们在患者护理中的作用。最初，卒中预测方案用于识别卒中风险最高的心房颤动患者，这些患者被认为最需要使用口服抗凝治疗。然而，随着新型、更安全、更方便的口服抗凝药物的出现，这些方案的作用已转变为识别卒中风险最低的患者，这些患者代表了少数不需要接受口服抗凝治疗的心房颤动患者。同时，还制定了出血风险预测方案，出血是口服抗凝治疗的主要风险。然而，由于这些方案的复杂性以及与卒中方案的显著相关性，其应用受到限制。一般来说，决定使用口服抗凝治疗应基于患者的卒中风险，并使用出血方案来确定出血的绝对禁忌证或可改变的危险因素。预测方案一直是有用的临床工具，在临床试验设计中具有不可估量的价值，并极大地辅助了经济分析。然而，这些方案的性质和作用现在正在适应新型口服抗凝药物的时代。
