从抗凝治疗中获益最大的非瓣膜性心房颤动患者的特征。
Characteristics of non-valvular atrial fibrillation patients who benefit most from anticoagulation treatment.
作者信息
Xing Yun-Li, Ma Qing, Ma Xiao-Ying, Wang Cui-Ying, Zhou Zhen, Huang Ying-Shuo, Sun Ying
机构信息
Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University Beijing, People's Republic of China.
School of Biomedical Engineering, Capital Medical University Beijing, People's Republic of China.
出版信息
Int J Clin Exp Med. 2015 Oct 15;8(10):18721-8. eCollection 2015.
OBJECTIVES
The objective was to determine who will benefit most from oral anticoagulation (OAC) for non-valvular atrial fibrillation (NVAF) patients aged ≥ 75 years.
BACKGROUND
It was unclear whether all of NVAF aged ≥ 75 should receive OAC.
METHODS
We recruited NVAF ≥ 75 years without QAC who were divided into three groups according to CHA2DS-VASc scores. The clinical endpoints were ischemic stroke (IS), thromboembolism (TE), or death.
RESULTS
The patients with CHA2DS2-VASc score of 6-9 were not appropriate for anticoagulation with the highest HAS-BLED scores. CHA2DS2-VASc of 2 had little risk for IS/TE. We further divided CHA2DS2-VASc of 3-5 into three subgroups with estimated glomerular filtration rate (eGFR; ml/min/1.73 m(2)): < 30, 30-60, and > 60. The patients with eGFR < 30 had the highest bleeding risk with a comparable IS/TE.
CONCLUSIONS
NVAF with CHA2DS2-VASc of 3-5 and eGFR > 30 ml/min/1.73 m(2) represent the most appropriate population for anticoagulation.
目的
本研究旨在确定年龄≥75岁的非瓣膜性心房颤动（NVAF）患者中，谁能从口服抗凝药（OAC）治疗中获益最大。
背景
年龄≥75岁的所有NVAF患者是否均应接受OAC治疗尚不清楚。
方法
我们招募了年龄≥75岁且未接受口服抗凝药治疗的NVAF患者，根据CHA2DS-VASc评分将其分为三组。临床终点为缺血性卒中（IS）、血栓栓塞（TE）或死亡。
结果
CHA2DS2-VASc评分为6-9分的患者抗凝治疗的HAS-BLED评分最高，不适合抗凝治疗。CHA2DS2-VASc评分为2分的患者发生IS/TE的风险较低。我们根据估算肾小球滤过率（eGFR；ml/min/1.73 m²）将CHA2DS2-VASc评分为3-5分的患者进一步分为三个亚组：<30、30-60和>60。eGFR<30的患者出血风险最高，IS/TE风险相当。
结论
CHA2DS2-VASc评分为3-5分且eGFR>30 ml/min/1.73 m²的NVAF患者是最适合接受抗凝治疗的人群。
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