Chen Pei-Chun, Lip Gregory Y H, Yeh Grace, Lin Hung-Ju, Chien Kuo-Liong
Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Tao-Yuan, Taiwan.
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
PLoS One. 2015 Apr 29;10(4):e0125257. doi: 10.1371/journal.pone.0125257. eCollection 2015.
Data on the use of oral anticoagulation (OAC) and antiplatelet therapy and the risk of bleeding and stroke amongst Asian patients with atrial fibrillation (AF) are limited. We investigated the risks of bleeding and stroke with use of oral anticoagulation (OAC) and antiplatelet therapy as mono- or combination therapy, in patients with AF from a Chinese nationwide cohort study.
We studied a cohort of 10384 patients (57.2% men, age 67.8 ± 13.2 yrs) between 1999 and 2010 from the National Health Insurance Research Database in Taiwan. Records of prescriptions were obtained during follow-up. The main outcome was a recurrent stroke during the follow-up period. Time-dependent Cox proportional hazards models were used for this analysis.
We documented 1009 events for bleeding, as well as 224 hemorrhagic stroke and 1642 ischemic stroke events during a median 3.2 (interquartile range, 1.05-6.54) years' follow-up. Compared with warfarin users, patients with antiplatelet therapy had a lower risk of bleeding (adjusted relative risk [RR], 0.59, 95% confidence interval [CI], 0.49-0.71, p<0.001) whilst combination therapy had a non-statistically significant higher bleeding risk (RR, 1.33, 95%, 0.91-1.94, p = 0.20). Patients on antiplatelet monotherapy had a similar risk for ischemic stroke compared with OAC (RR 1.05, 95% CI, 0.89-1.25, p = 0.50), whilst those on combination therapy had a significantly higher risk (RR 1.90, 95% CI, 1.34-2.70, p<0.001).
In a national representative cohort, antiplatelet therapy had no significant difference in ischemic stroke risk to warfarin. For bleeding, aspirin had a lower risk compared to warfarin. This may reflect poor anticoagulation control, highlighting important missed opportunities for improved stroke prevention, especially in countries where anticoagulation management is suboptimal.
关于亚洲房颤（AF）患者口服抗凝药（OAC）和抗血小板治疗的使用情况以及出血和中风风险的数据有限。我们在中国一项全国性队列研究中，调查了房颤患者使用口服抗凝药（OAC）和抗血小板治疗作为单一疗法或联合疗法时的出血和中风风险。
我们研究了1999年至2010年间来自台湾国民健康保险研究数据库的10384名患者（男性占57.2%，年龄67.8±13.2岁）的队列。随访期间获取处方记录。主要结局是随访期间复发性中风。本分析使用时间依赖性Cox比例风险模型。
在中位3.2年（四分位间距，1.05 - 6.54年）的随访期间，我们记录了1009例出血事件，以及224例出血性中风和1642例缺血性中风事件。与使用华法林的患者相比，接受抗血小板治疗的患者出血风险较低（调整后相对风险[RR]，0.59，95%置信区间[CI]，0.49 - 0.71，p<0.001），而联合治疗的出血风险无统计学显著升高（RR，1.33，95%，0.91 - 1.94，p = 0.20）。抗血小板单药治疗的患者与口服抗凝药相比，缺血性中风风险相似（RR 1.05，95% CI，0.89 - 1.25，p = 0.50），而联合治疗的患者风险显著更高（RR 1.90，95% CI，1.34 - 2.70，p<0.001）。
在一个全国代表性队列中，抗血小板治疗在缺血性中风风险方面与华法林无显著差异。对于出血，阿司匹林的风险低于华法林。这可能反映了抗凝控制不佳，突出了改善中风预防的重要错失机会，尤其是在抗凝管理欠佳的国家。
