Deambrosis Paola, Bettiol Alessandra, Bolcato Jenny, Pirolo Roberta, Franchin Giulia, Themistoclakis Sakis, Pellizzari Michele, Chinellato Alessandro, Giusti Pietro
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Acta Pharm. 2017 Jun 27;67(2):227-236. doi: 10.1515/acph-2017-0016.
This retrospective observational study was based on databases of the Local Health Authority of Treviso, Italy. It evaluated the prevalence and the effectiveness of oral anticoagulation treatment (OAT) for the management of nonvalvular atrial fibrillation (NVAF) in everyday clinical practice. Out of 6,138 NVAF patients, only 3,024 received vitamin K antagonist (VKA). Potential barriers decreasing the probability of being treated with VKA were female sex, older age, antiplatelet treatment and history of bleeding. In addition, VKA-treatment was not in line with current ESC and AIAC guidelines, since the patients at high or low risk of stroke were under- or over-treated, resp. Among VKAtreated patients, 73 % of subjects were not at target with anticoagulation. OAT resulted to be effective in reducing stroke risk. However, stroke events were significantly influenced also by previous stroke or transient ischemic attack (hazard ratio, HR = 2.99, p < 0.001) and by previous bleeding events (HR = 1.60, p < 0.001).
这项回顾性观察性研究基于意大利特雷维索地方卫生局的数据库。它评估了在日常临床实践中口服抗凝治疗（OAT）用于非瓣膜性心房颤动（NVAF）管理的患病率和有效性。在6138例NVAF患者中，仅有3024例接受了维生素K拮抗剂（VKA）治疗。降低接受VKA治疗可能性的潜在障碍包括女性、年龄较大、抗血小板治疗和出血史。此外，VKA治疗不符合当前欧洲心脏病学会（ESC）和意大利心脏病学会（AIAC）的指南，因为中风高风险或低风险患者分别接受了不足或过度的治疗。在接受VKA治疗的患者中，73%的受试者抗凝未达目标。OAT在降低中风风险方面是有效的。然而，中风事件也受到既往中风或短暂性脑缺血发作（风险比，HR = 2.99，p < 0.001）以及既往出血事件（HR = 1.60，p < 0.001）的显著影响。
