Manaktala Rohini, Kluger Jeffrey
J Am Osteopath Assoc. 2017 Dec 1;117(12):761-771. doi: 10.7556/jaoa.2017.148.
Patients with atrial fibrillation are at increased risk of having a cardioembolic stroke. The use of oral anticoagulation is now well established to prevent strokes in patients with atrial fibrillation and a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years [2 points], diabetes mellitus, prior stroke/transient ischemic attack or thromboembolism [2 points], vascular disease, age 65 to 74 years, and sex category) score of greater than 1, beyond sex. However, the role of antiplatelet therapy, specifically aspirin in low-risk patients or as an alternative to oral anticoagulation, remains controversial. The most recent US guidelines conflict with the European guidelines, which do not recommend antiplatelet monotherapy for stroke prevention irrespective of stroke risk. The aim of this review is to summarize published studies that question the role of aspirin in preventing strokes associated with atrial fibrillation. Overall, aspirin is found to play a limited role in the prevention of stroke in patients with atrial fibrillation and is associated with a similar risk of hemorrhagic events compared with anticoagulants. The benefit of dual antiplatelet therapy as an alternative to oral anticoagulation requires further study.
心房颤动患者发生心源性栓塞性卒中的风险增加。目前，口服抗凝治疗已被充分证实可预防心房颤动且CHA2DS2-VASc（充血性心力衰竭、高血压、年龄≥75岁[2分]、糖尿病、既往卒中/短暂性脑缺血发作或血栓栓塞[2分]、血管疾病、年龄65至74岁以及性别分类）评分大于1（不考虑性别）的患者发生卒中。然而，抗血小板治疗的作用，特别是阿司匹林在低风险患者中的作用或作为口服抗凝治疗的替代方案，仍存在争议。美国最新指南与欧洲指南存在冲突，欧洲指南不推荐无论卒中风险如何均使用抗血小板单药治疗来预防卒中。本综述的目的是总结对阿司匹林在预防与心房颤动相关卒中方面的作用提出质疑的已发表研究。总体而言，阿司匹林在预防心房颤动患者卒中方面作用有限，且与抗凝剂相比，出血事件风险相似。双联抗血小板治疗作为口服抗凝治疗替代方案的益处需要进一步研究。
