Division of Heart Rhythm Services, Department of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
Division of Cardiovascular Medicine, Department of Internal Medicine, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA.
Eur Heart J. 2019 Apr 21;40(16):1294-1302. doi: 10.1093/eurheartj/ehy731.
Despite the demonstrable success of oral anticoagulants in reducing the rate of stroke in patients with atrial fibrillation, they continue to be seriously underutilized. Indications for their use as stated in the guidelines incorporate a number of risk score algorithms, the most widely used being the CHA2DS2-VASc score. Nonetheless there are several limitations to the various scores currently in clinical use and a critique of these is the focus of this review. In this review we discuss the pathophysiology of atrial fibrillation and its role in thromboembolic stroke risk. We amalgamate this with the basis of major professional society anticoagulation recommendations with regards to the strengths and limitations of current risk stratification strategies and discuss gaps in our current evidence base and next steps to address those gaps.
尽管口服抗凝剂在降低房颤患者中风发生率方面取得了显著成效，但它们的使用率仍然严重偏低。指南中规定了它们的使用适应症，其中包括许多风险评分算法，应用最广泛的是 CHA2DS2-VASc 评分。然而，目前临床上使用的各种评分方法都存在一定的局限性，本综述的重点就是对这些评分进行评价。在本综述中，我们讨论了房颤的病理生理学及其在血栓栓塞性中风风险中的作用。我们将这与主要专业学会的抗凝建议相结合，讨论了当前风险分层策略的优缺点，并探讨了我们当前证据基础中的差距以及解决这些差距的下一步措施。
