抗凝治疗与新发房颤患者的卒中及死亡人群风险：一项基于人群的队列研究。
Anticoagulation and population risk of stroke and death in incident atrial fibrillation: a population-based cohort study.
作者信息
Yu Amy Y X, Malo Shaun, Wilton Stephen, Parkash Ratika, Svenson Lawrence W, Hill Michael D
机构信息
Department of Clinical Neurosciences (Yu), University of Calgary, Calgary, Alta.; Surveillance and Assessment Branch (Malo, Svenson), Alberta Health, Edmonton, Alta.; Libin Cardiovascular Institute (Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Parkash), Queen Elizabeth II Health Sciences Center, Halifax, NS; School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences and Community Health Sciences (Hill), University of Calgary, Calgary, Alta.
出版信息
CMAJ Open. 2016 Jan 7;4(1):E1-6. doi: 10.9778/cmajo.20150096. eCollection 2016 Jan-Mar.
BACKGROUND
Atrial fibrillation increases the risk of stroke and death. Anticoagulation therapy is an effective treatment for stroke prevention, but remains underused in the community. We sought to determine the effectiveness and safety of anticoagulation therapy in an inception cohort with new-onset atrial fibrillation in the province of Alberta, Canada.
METHODS
We conducted a population-based cohort study of atrial fibrillation using an administrative database from Alberta's publicly funded and universally available health care system. All new-onset atrial fibrillation patients from Jan. 1, 2009, to Dec. 31, 2010, were included in the cohort and followed through Dec. 31, 2013. We assessed anticoagulation status as a predictor of stroke and death using time-to-event analysis and adjusted for sex and CHADS2 (congestive heart failure, hypertension, age ≥ 75 yr, diabetes mellitus and prior stroke or transient ischemic attack) score using Cox proportional hazards modelling.
RESULTS
We identified 10 745 patients, 7358 (68.5%) of whom received anticoagulation therapy, principally with warfarin (n = 6997, 95.1%). Anticoagulation therapy was associated with significantly decreased risk of ischemic stroke (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.58-0.82), all stroke (HR 0.77, 95% CI 0.65-0.91), all stroke and death (HR 0.70, 95% CI 0.62-0.72) and all-cause mortality (HR 0.67, 95% CI 0.62-0.72), despite an association with increased risk of hemorrhagic stroke (HR 1.92, 95% CI 1.17-3.16). There was a neutral association with subdural (HR 1.01, 95% CI 0.53-1.93) and gastrointestinal (HR 0.96, 95% CI 0.70-1.31) hemorrhage.
INTERPRETATION
Anticoagulation therapy is effective and safe for stroke prevention and decreases mortality in patients with incident atrial fibrillation. These population data support an aggressive approach to screening for atrial fibrillation and treatment with anticoagulant medicines to prevent stroke and death.
背景
心房颤动会增加中风和死亡风险。抗凝治疗是预防中风的有效方法，但在社区中仍未得到充分应用。我们试图确定在加拿大艾伯塔省一个新发心房颤动的起始队列中抗凝治疗的有效性和安全性。
方法
我们利用艾伯塔省公共资助且普遍可用的医疗保健系统的行政数据库，对心房颤动进行了一项基于人群的队列研究。该队列纳入了2009年1月1日至2010年12月31日期间所有新发心房颤动患者，并随访至2013年12月31日。我们使用事件发生时间分析评估抗凝状态作为中风和死亡的预测因素，并使用Cox比例风险模型对性别和CHADS2（充血性心力衰竭、高血压、年龄≥75岁、糖尿病以及既往中风或短暂性脑缺血发作）评分进行调整。
结果
我们识别出10745例患者，其中7358例（68.5%）接受了抗凝治疗，主要使用华法林（n = 6997，95.1%）。抗凝治疗与缺血性中风风险显著降低相关（风险比[HR] 0.69，95%置信区间[CI] 0.58 - 0.82）、所有中风（HR 0.77，95% CI 0.65 - 0.91）、所有中风和死亡（HR 0.70，95% CI 0.62 - 0.72）以及全因死亡率（HR 0.67，95% CI 0.62 - 0.72），尽管与出血性中风风险增加相关（HR 1.92，95% CI 1.17 - 3.16）。与硬膜下出血（HR 1.01，95% CI 0.53 - 1.93）和胃肠道出血（HR 0.96，95% CI 0.70 - 1.31）呈中性关联。
解读
抗凝治疗对于预防中风是有效且安全的，并可降低新发心房颤动患者的死亡率。这些人群数据支持积极筛查心房颤动并用抗凝药物进行治疗以预防中风和死亡的方法。
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