Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California.
VA Eastern Colorado Health Care System/University of Colorado School of Medicine, Denver, Colorado.
J Am Coll Cardiol. 2016 Jun 28;67(25):2913-23. doi: 10.1016/j.jacc.2016.03.581.
Oral anticoagulation (OAC), rather than aspirin, is recommended in patients with atrial fibrillation (AF) at moderate to high risk of stroke.
This study sought to examine patient and practice-level factors associated with prescription of aspirin alone compared with OAC in AF patients at intermediate to high stroke risk in real-world cardiology practices.
The authors identified 2 cohorts of outpatients with AF and intermediate to high thromboembolic risk (CHADS2 score ≥2 and CHA2DS2-VASc ≥2) enrolled in the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) registry between 2008 and 2012. Using hierarchical modified Poisson regression models adjusted for patient and practice characteristics, the authors examined the prevalence and predictors of aspirin alone versus OAC prescription in AF patients at risk for stroke.
Of 210,380 identified patients with CHADS2 score ≥2 on antithrombotic therapy, 80,371 (38.2%) were treated with aspirin alone, and 130,009 (61.8%) were treated with warfarin or non-vitamin K antagonist OACs. In the cohort of 294,642 patients with CHA2DS2-VASc ≥2, 118,398 (40.2%) were treated with aspirin alone, and 176,244 (59.8%) were treated with warfarin or non-vitamin K antagonist OACs. After multivariable adjustment, hypertension, dyslipidemia, coronary artery disease, prior myocardial infarction, unstable and stable angina, recent coronary artery bypass graft, and peripheral arterial disease were associated with prescription of aspirin only, whereas male sex, higher body mass index, prior stroke/transient ischemic attack, prior systemic embolism, and congestive heart failure were associated with more frequent prescription of OAC.
In a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC. Specific patient characteristics predicted prescription of aspirin therapy over OAC.
对于中高危卒中风险的房颤（AF）患者，推荐使用口服抗凝剂（OAC）而非阿司匹林。
本研究旨在检查在真实世界的心脏病学实践中，对于中高危卒中风险的 AF 患者，与 OAC 相比，处方单独使用阿司匹林的患者和实践因素。
作者确定了 2 个队列的 AF 门诊患者，其具有中高危血栓栓塞风险（CHADS2 评分≥2 且 CHA2DS2-VASc≥2），于 2008 年至 2012 年期间纳入美国心脏病学会 PINNACLE（实践创新和临床卓越）注册研究。使用分层修正泊松回归模型，根据患者和实践特征进行调整，作者检查了在有卒中风险的 AF 患者中，单独使用阿司匹林与 OAC 处方的流行率和预测因素。
在接受抗血栓治疗的 210380 名 CHADS2 评分≥2 的患者中，有 80371 名（38.2%）接受单独的阿司匹林治疗，130009 名（61.8%）接受华法林或非维生素 K 拮抗剂 OAC 治疗。在 294642 名 CHA2DS2-VASc≥2 的患者中，有 118398 名（40.2%）接受单独的阿司匹林治疗，176244 名（59.8%）接受华法林或非维生素 K 拮抗剂 OAC 治疗。经多变量调整后，高血压、血脂异常、冠状动脉疾病、既往心肌梗死、不稳定型和稳定型心绞痛、近期冠状动脉旁路移植术和外周动脉疾病与单独使用阿司匹林相关，而男性、较高的体重指数、既往卒中/短暂性脑缺血发作、既往全身性栓塞和充血性心力衰竭与更频繁地使用 OAC 相关。
在中高危卒中风险的 AF 患者的大型真实世界心脏门诊人群中，超过 1/3 的患者未接受 OAC 治疗，而仅接受阿司匹林治疗。特定的患者特征预测了 OAC 治疗的处方。
