aHeart Center, Tampere University Hospital, Tampere bHeart Center, Kuopio University Hospital, Kuopio cOulu University Hospital, Oulu dHeart and Lung Center, Helsinki University Hospital, Helsinki eTurku University Hospital, Turku fUniversity of Eastern Finland, Jyväskylä, Finland.
Eur J Emerg Med. 2017 Oct;24(5):347-352. doi: 10.1097/MEJ.0000000000000402.
Atrial fibrillation (AF) causes numerous visits to emergency departments (EDs). We evaluated the thromboembolic and bleeding risk profile and use of oral anticoagulation (OAC) therapy among patients presenting with symptomatic AF to ED.
Within a 2-week period, all patients whose primary reason for the ED visit was AF were enrolled into this prospective study in 35 EDs around Finland. The risk of thromboembolic and bleeding events was assessed by the CHA2DS2VASc and the HAS-BLED score, respectively. Thereafter, we evaluated whether OAC was used according to the contemporary management guidelines.
The study population included 1013 patients (mean age 70±13 years, 52.4% men) with newly or previously diagnosed symptomatic AF. The mean CHA2DS2VASc and HAS-BLED score was 3.1±2.1 and 1.9±1.2, respectively. At admission, 76.3% of the patients with previously diagnosed AF and CHA2DS2VASc score of at least 2 were using OAC (warfarin 92.3%). However, the international normalized ratio was not at the therapeutic level in 41.9% of them. At discharge, 84.1% of the high-risk patients (85.5% of previously diagnosed and 79.6% of newly diagnosed) and 57.0 and 37.0% of the moderate-risk and low-risk patients were on OAC, respectively. Of the high-risk patients, 5.4% were treated with aspirin.
These data showed that OAC was prescribed frequently to patients with symptomatic AF and risk factors for stroke. However, in patients using warfarin, international normalized ratio was not at the therapeutic level in a large proportion of the patients with previously diagnosed AF.
心房颤动（AF）会导致许多人到急诊科（ED）就诊。我们评估了因症状性 AF 到 ED 就诊的患者的血栓栓塞和出血风险概况以及口服抗凝剂（OAC）治疗的使用情况。
在两周的时间内，芬兰各地的 35 家急诊科将所有因 ED 就诊的主要原因为 AF 的患者纳入这项前瞻性研究。血栓栓塞和出血事件的风险分别通过 CHA2DS2VASc 和 HAS-BLED 评分进行评估。此后，我们评估了是否根据当代管理指南使用了 OAC。
研究人群包括 1013 名（平均年龄 70±13 岁，52.4%为男性）新诊断或既往诊断为症状性 AF 的患者。平均 CHA2DS2VASc 和 HAS-BLED 评分为 3.1±2.1 和 1.9±1.2。入院时，76.3%的既往诊断为 AF 且 CHA2DS2VASc 评分≥2 的患者正在使用 OAC（华法林 92.3%）。然而，其中 41.9%的患者国际标准化比值未达到治疗水平。出院时，84.1%的高危患者（既往诊断的 85.5%和新诊断的 79.6%）、57.0%和 37.0%的中危和低危患者分别接受了 OAC 治疗。高危患者中有 5.4%使用了阿司匹林。
这些数据表明，对于有症状性 AF 和中风风险因素的患者，经常开具 OAC 处方。然而，在使用华法林的患者中，既往诊断为 AF 的患者中很大一部分患者的国际标准化比值未达到治疗水平。
