Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
Thrombosis Research Institute, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK.
Eur Heart J. 2018 Feb 7;39(6):464-473. doi: 10.1093/eurheartj/ehx730.
Current atrial fibrillation (AF) guidelines discourage antiplatelet (AP) monotherapy as alternative to anticoagulants (ACs). Why AP only is still used is largely unknown.
Factors associated with AP monotherapy prescription were analysed in GARFIELD-AF, a registry of patients with newly diagnosed (≤6 weeks) AF and ≥1 investigator-determined stroke risk factor. We analysed 51 270 patients from 35 countries enrolled into five sequential cohorts between 2010 and 2016. Overall, 20.7% of patients received AP monotherapy, 52.1% AC monotherapy, and 14.1% AP + AC. Most AP monotherapy (82.5%) and AC monotherapy (86.8%) patients were CHA2DS2-VASc ≥2. Compared with patients on AC monotherapy, AP monotherapy patients were frequently Chinese (vs. Caucasian, odds ratio 2.73) and more likely to have persistent AF (1.32), history of coronary artery disease (2.41) or other vascular disease (1.67), bleeding (2.11), or dementia (1.81). The odds for AP monotherapy increased with 5 years of age increments for patients ≥75 years (1.24) but decreased with age increments for patients 55-75 years (0.86). Antiplatelet monotherapy patients were less likely to have paroxysmal (0.67) or permanent AF (0.57), history of embolism (0.56), or alcohol use (0.90). With each cohort, AP monotherapy declined (P<0.0001), especially non-indicated use. AP + AC and no antithrombotic therapy were unchanged. However, even in 2015 and 2016, about 50% of AP-treated patients had no indication except AF (71% were CHA2DS2-VASc ≥2).
Prescribing AP monotherapy in newly diagnosed AF has declined, but even nowadays a substantial proportion of AP-treated patients with AF have no indication for AP.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
目前的房颤（AF）指南不鼓励抗血小板（AP）单药治疗作为抗凝剂（ACs）的替代方案。为什么仍然使用 AP 单药治疗很大程度上是未知的。
在 GARFIELD-AF 中分析了与 AP 单药治疗处方相关的因素，这是一项新诊断（≤6 周）AF 和≥1 项研究者确定的中风危险因素患者的登记研究。我们分析了 2010 年至 2016 年期间在 35 个国家入组的 51270 名患者，共分为五个连续队列。总体而言，20.7%的患者接受 AP 单药治疗，52.1%的患者接受 AC 单药治疗，14.1%的患者接受 AP+AC 联合治疗。大多数 AP 单药治疗（82.5%）和 AC 单药治疗（86.8%）患者的 CHA2DS2-VASc≥2。与接受 AC 单药治疗的患者相比，AP 单药治疗的患者多为中国人（与白种人相比，优势比 2.73），更有可能患有持续性 AF（1.32）、冠心病（2.41）或其他血管疾病（1.67）、出血（2.11）或痴呆（1.81）。≥75 岁的患者每增加 5 岁，AP 单药治疗的可能性增加 1.24，但 55-75 岁的患者年龄每增加 1 岁，AP 单药治疗的可能性降低 0.86。AP 单药治疗的患者发生阵发性（0.67）或永久性 AF（0.57）、栓塞史（0.56）或酒精使用史（0.90）的可能性较低。随着每一批队列的出现，AP 单药治疗的比例都有所下降（P<0.0001），尤其是不适当的应用。AP+AC 和无抗血栓治疗则保持不变。然而，即使在 2015 年和 2016 年，约有 50%的接受 AP 治疗的 AF 患者除 AF 外没有其他适应证（71%的患者 CHA2DS2-VASc≥2）。
新诊断的 AF 中 AP 单药治疗的应用有所减少，但即使在今天，仍有相当一部分接受 AP 治疗的 AF 患者没有使用 AP 的适应证。
