Abraham JoEllyn M, Connolly Stuart J
Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA,
Heart Fail Rev. 2014 May;19(3):305-13. doi: 10.1007/s10741-014-9420-4.
For an individual patient with both atrial fibrillation and heart failure, stroke risk is one of the most prominent mitigating factors for subsequent morbidity and mortality. Although the CHADS₂ stroke risk score is the most widely used score for risk stratification, it does not take into account the risk factors of vascular disease, female gender, or the age group 65-74 years, for which there is increasing evidence. There is also evidence that diastolic heart failure is as much a risk factor for stroke as systolic heart failure. The new oral anticoagulants dabigatran, rivaroxaban and apixaban appear to be appropriate agents in the heart failure population with atrial fibrillation and risk factors for stroke although there are dose-adjustments for renal insufficiency and these medications are contraindicated in advanced renal disease. As with the atrial fibrillation population as a whole, bleeding risk should be considered for every patient with heart failure prior to making recommendations regarding anticoagulation.
对于同时患有心房颤动和心力衰竭的个体患者，中风风险是影响后续发病率和死亡率的最显著缓解因素之一。尽管CHADS₂中风风险评分是风险分层中使用最广泛的评分，但它没有考虑到血管疾病、女性性别或65 - 74岁年龄组的风险因素，而针对这些因素的证据越来越多。也有证据表明，舒张性心力衰竭与收缩性心力衰竭一样，都是中风的风险因素。新型口服抗凝药达比加群、利伐沙班和阿哌沙班似乎是患有心房颤动且有中风风险因素的心力衰竭人群的合适药物，尽管对于肾功能不全患者需要调整剂量，并且这些药物在晚期肾病中是禁忌的。与整个心房颤动人群一样，在对抗凝治疗提出建议之前，应考虑每一位心力衰竭患者的出血风险。
