Dupree Lori, DeLosSantos Marci, Smotherman Carmen
1 Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, UF Health Jacksonville, FL, USA.
2 Department of Pharmacy, UF Health Jacksonville, Jacksonville, FL, USA.
J Cardiovasc Pharmacol Ther. 2018 Nov;23(6):502-508. doi: 10.1177/1074248418778804. Epub 2018 May 27.
Risk stratification for stroke in patients with atrial fibrillation is a vital step in identifying whether antithrombotic therapy is indicated for stroke prevention in this common arrhythmia.
The aim of this study was to determine adherence to guideline-directed antithrombotic therapy based on Congestive Heart Failure (1 point), Hypertension (1 point), Age (≥75 years old is 2 points and 65-74 is 1 point), Diabetes (1 point), prior Stroke (2 points), Vascular Disease (1 point), and Sex Category (1 point if female; CHADS-VASc) score in patients with atrial fibrillation (AF) on hospital discharge.
A total of 293 patients discharged from this academic medical center with a history of atrial fibrillation from June 2014 to June 2016 were enrolled. Demographic data and indicators for antithrombotic therapy based on the CHADS-VASc score were recorded, and factors that affected adherence to guideline-directed therapy, such as bleeding risk, falls, and alcohol abuse, were collected and analyzed.
At hospital discharge, 63% of patients with AF were on appropriate antithrombotic therapy, 50% with a CHADS-VASc score ≥2. The odds ratio of appropriate therapy in patients with a CHADS-VASc score ≥2 was 1.17 (95% confidence interval [CI]: 0.95-1.30; P = .18). When chart documentation for reasons to withhold anticoagulation was considered as appropriate therapy, 81% of patients with AF were discharged on appropriate antithrombotic therapy with an odds ratio of 1.57 (95% CI: 1.26 -1.96, P < .0001), with bleeding and falls risk as the most common reasons to withhold anticoagulation.
Based on risk stratification of stroke through the CHADS-VASc score, the majority of patients with AF were discharged from the hospital on appropriate antithrombotic therapy. Withholding anticoagulation due to falls risk should be reconsidered as a result of the known benefits of stroke prevention in atrial fibrillation.
心房颤动患者的卒中风险分层是确定这种常见心律失常患者是否需要进行抗血栓治疗以预防卒中的关键步骤。
本研究旨在根据充血性心力衰竭（1分）、高血压（1分）、年龄（≥75岁为2分，65 - 74岁为1分）、糖尿病（1分）、既往卒中（2分）、血管疾病（1分）和性别类别（女性为1分；CHADS-VASc）评分，确定心房颤动（AF）患者出院时对指南指导的抗血栓治疗的依从性。
纳入2014年6月至2016年6月从该学术医疗中心出院的293例有房颤病史的患者。记录人口统计学数据和基于CHADS-VASc评分的抗血栓治疗指标，并收集和分析影响指南指导治疗依从性的因素，如出血风险、跌倒和酗酒。
出院时，63%的房颤患者接受了适当的抗血栓治疗，CHADS-VASc评分≥2的患者中这一比例为50%。CHADS-VASc评分≥2的患者接受适当治疗的比值比为1.17（95%置信区间[CI]：0.95 - 1.30；P = 0.18）。当将因停用抗凝治疗的原因的病历记录视为适当治疗时，81%的房颤患者出院时接受了适当的抗血栓治疗，比值比为1.57（95%CI：1.26 - 1.96，P < 0.0001），出血和跌倒风险是停用抗凝治疗的最常见原因。
基于通过CHADS-VASc评分进行的卒中风险分层，大多数房颤患者出院时接受了适当的抗血栓治疗。鉴于心房颤动卒中预防的已知益处，因跌倒风险而停用抗凝治疗应重新考虑。
