Hsu Jonathan C, Chan Paul S, Tang Fengming, Maddox Thomas M, Marcus Gregory M
Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego.
Mid America Heart Institute, Kansas City, Missouri3Department of Internal Medicine, University of Missouri, Kansas City.
JAMA Intern Med. 2015 Jun;175(6):1062-5. doi: 10.1001/jamainternmed.2015.0920.
We sought to investigate the prevalence and predictors of oral anticoagulation prescription among patients with atrial fibrillation (AF) at the lowest risk for thromboembolism, despite contemporary consensus guidelines that do not recommend anticoagulation therapy in this population.
In young and healthy AF patients without significant thromboembolic risk factors, anticoagulant treatment carries bleeding risks that outweigh stroke prevention benefit.
Within a large contemporary registry of cardiology outpatients, we identified low-risk patients with AF meeting criteria for a contemporary consensus guideline class III indication against use of anticoagulation (age < 60 years, CHADS Score=0, and no structural heart disease) between 2008–2012, and a second cohort with the same criteria and a CHADS-VASc Score of 0. Using hierarchical modified Poisson regression models adjusted for patient characteristics, we examined predictors of oral anticoagulation treatment in these low thromboembolic risk AF patients.
Oral anticoagulation was prescribed in a total of 2,561 of 10,995 (23.2%) AF patients with a CHADS score of 0 and 1,787 of 6,730 (26.6%) AF patients with a CHADS-VASc score of 0. In multivariable analysis, older age (RR 1.48 per 10 years; 95% CI, 1.41–1.56; p<0.0001), male sex (RR 1.34; 95% CI, 1.22–1.46; p<0.0001), higher body mass index (RR 1.18 per 5 kg/m; 95% CI, 1.14–1.22; p<0.0001), and Medicare insurance (reference: private insurance; RR,1.32; 95% CI, 1.17–1.49; overall p<0.0001) were associated with a higher likelihood of oral anticoagulant prescription, whereas treatment in Southern states (reference: Northeast; RR 0.69; 95% CI, 0.49–0.98;overall p=0.1187) was associated with a lower likelihood of oral anticoagulant prescription.
In a large, real-world population of AF patients with the lowest thrombotic risk, approximately 1 in 4 were treated with oral anticoagulation against contemporary guideline recommendations.
尽管当代共识指南不建议对血栓栓塞风险最低的房颤（AF）患者进行抗凝治疗，但我们试图调查此类患者口服抗凝治疗的处方率及预测因素。
在无显著血栓栓塞风险因素的年轻健康房颤患者中，抗凝治疗带来的出血风险超过预防中风的益处。
在一个大型当代心脏病门诊患者登记系统中，我们确定了2008年至2012年间符合当代共识指南III类指征（即不使用抗凝治疗，年龄<60岁，CHADS评分=0，且无结构性心脏病）的低风险房颤患者，以及另一组具有相同标准且CHADS-VASc评分为0的患者。我们使用针对患者特征进行调整的分层修正泊松回归模型，研究这些低血栓栓塞风险房颤患者口服抗凝治疗的预测因素。
CHADS评分为0的10995例房颤患者中，共有2561例（23.2%）接受了口服抗凝治疗；CHADS-VASc评分为0的6730例房颤患者中，有1787例（26.6%）接受了口服抗凝治疗。在多变量分析中，年龄较大（每10岁风险比[RR]为1.48；95%置信区间[CI]，1.41 - 1.56；p<0.0001）、男性（RR为1.34；95%CI，
