Suppr超能文献

非维生素 K 拮抗剂口服抗凝剂在伴有肥厚型心肌病的心房颤动患者中的有效性和安全性:一项全国性队列研究。

Effectiveness and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation With Hypertrophic Cardiomyopathy: A Nationwide Cohort Study.

机构信息

Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.

Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.

出版信息

Chest. 2019 Feb;155(2):354-363. doi: 10.1016/j.chest.2018.11.009. Epub 2018 Nov 22.

Abstract

BACKGROUND

Chronic anticoagulation is recommended in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF). Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative to warfarin, but there are limited data to support their use in patients with HCM and AF. We sought to compare thromboembolic events, bleeding, and mortality between NOAC and warfarin in patients with HCM and AF.

METHODS

From the Korean National Health Insurance Service database during the period from January 1, 2011, to December 31, 2016, we identified a warfarin-treated group of patients with HCM and AF (n = 955) who were compared with a 1:2 propensity-matched NOAC treated group (n = 1,504).

RESULTS

After a median follow-up of 16 months, the incidence rates of ischemic stroke and major bleeding were similar between NOAC- and warfarin-treated patients with HCM and AF. NOAC-treated patients had lower incidence rates for all-cause mortality (5.11 and 10.13 events per 100 person-years for NOAC and warfarin groups) and the composite of fatal cardiovascular events (0.77 and 1.80 events per 100 person-years). Compared with warfarin, use of NOACs was associated with a significantly lower risk of all cause-mortality (hazard ratio, 0.43; 95% CI, 0.32-0.57) and composite fatal cardiovascular events (hazard ratio, 0.39; 95% CI, 0.18-0.82).

CONCLUSIONS

Compared with warfarin, patients with HCM and AF on NOACs had similar stroke and major bleeding risks, but lower all-cause mortality and composite fatal cardiovascular events. Our data suggest that patients with HCM and AF can be safely and effectively treated with NOACs.

摘要

背景

肥厚型心肌病(HCM)和心房颤动(AF)患者推荐进行慢性抗凝治疗。非维生素 K 拮抗剂口服抗凝剂(NOAC)是华法林的替代药物,但目前支持其在 HCM 和 AF 患者中使用的数据有限。我们旨在比较 HCM 和 AF 患者中使用 NOAC 和华法林的血栓栓塞事件、出血和死亡率。

方法

我们从 2011 年 1 月 1 日至 2016 年 12 月 31 日的韩国国家健康保险服务数据库中,确定了一组接受华法林治疗的 HCM 和 AF 患者(n=955),并与 1:2 倾向评分匹配的接受 NOAC 治疗的患者(n=1504)进行比较。

结果

中位随访 16 个月后,NOAC 和华法林治疗的 HCM 和 AF 患者的缺血性卒中发生率和主要出血发生率相似。NOAC 治疗的患者全因死亡率(NOAC 组和华法林组分别为每 100 人年 5.11 和 10.13 例事件)和致命心血管事件综合发生率(NOAC 组和华法林组分别为每 100 人年 0.77 和 1.80 例事件)较低。与华法林相比,NOAC 的使用与全因死亡率(风险比,0.43;95%CI,0.32-0.57)和致命心血管事件综合发生率(风险比,0.39;95%CI,0.18-0.82)显著降低相关。

结论

与华法林相比,接受 NOAC 治疗的 HCM 和 AF 患者的卒中风险和主要出血风险相似,但全因死亡率和致命心血管事件综合发生率较低。我们的数据表明,NOAC 可安全有效地治疗 HCM 和 AF 患者。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验