Gorczyca Iwona, Michalska Anna, Chrapek Magdalena, Jelonek Olga, Wałek Paweł, Wożakowska-Kapłon Beata
1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Center, Kielce, Poland.
Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.
Cardiol J. 2021;28(6):896-904. doi: 10.5603/CJ.a2019.0069. Epub 2019 Jul 17.
Oral anticoagulants (OAC) are recommended in all patients with atrial fibrillation (AF) after thromboembolic events without contraindications. It is hypothesized herein, that the majority of patients with AF after thromboembolic events receive OAC and the presence of specific factors, predisposes the use of non-vitamin K antagonist oral anticoagulants (NOACs).
This is a retrospective study, encompassing patients with AF hospitalized in a reference cardiology center over the years 2014-2017. Thromboembolic events were defined as: ischemic stroke, transient ischemic attack and systemic embolism. Inclusion criteria were the following: diagnosis of non-valvular AF at discharge from hospital, hospitalization not resulting in death.
Among 2834 hospitalized patients with AF, a history of thromboembolic events was identified in 347 (12.2%) patients. In the group studied, of 347 patients with AF after a thromboembolic event, 322 (92.8%) received OAC, including 133 patients on vitamin K antagonist (41.3% of patients on OAC) and 189 patients on NOACs (58.7% of patients on OAC). Among patients treated with NOACs the majority were on dabigatran (116 patients, 61.4%), followed by rivaroxaban (54 patients, 28.6%), and apixaban (19 patients, 10%). Multivariate logistic regression analysis demonstrated that the presence of arterial hypertension reduced the chance for NOACs use (odds ratio [OR] 0.4, 95% confidence interval [CI] 0.2-0.9, p = 0.04) and left atrial size ≤ 40 mm was a factor increasing the chance for the use of NOACs (OR 2.5, 95% CI 1.1-5.8, p = 0.03).
Nearly all hospitalized patients with AF received OAC in the secondary prevention of thromboembolic complications. NOACs were used for secondary prevention of stroke among patients with AF in patients with fewer comorbidities.
对于所有发生血栓栓塞事件且无禁忌证的心房颤动（AF）患者，均推荐使用口服抗凝剂（OAC）。本文提出假设，即大多数发生血栓栓塞事件后的AF患者接受了OAC治疗，且特定因素的存在会促使非维生素K拮抗剂口服抗凝剂（NOAC）的使用。
这是一项回顾性研究，纳入了2014年至2017年期间在一家参考心脏病中心住院的AF患者。血栓栓塞事件定义为：缺血性卒中、短暂性脑缺血发作和全身性栓塞。纳入标准如下：出院时诊断为非瓣膜性AF，住院未导致死亡。
在2834例住院的AF患者中，347例（12.2%）有血栓栓塞事件史。在研究组的347例发生血栓栓塞事件后的AF患者中，322例（92.8%）接受了OAC治疗，其中133例使用维生素K拮抗剂（占接受OAC治疗患者的41.3%），189例使用NOAC（占接受OAC治疗患者的58.7%）。在接受NOAC治疗的患者中，大多数使用达比加群（116例，61.4%），其次是利伐沙班（54例，28.6%）和阿哌沙班（19例，10%）。多因素逻辑回归分析表明，动脉高血压的存在降低了使用NOAC的机会（比值比[OR]0.4，95%置信区间[CI]0.2 - 0.9，p = 0.04），左心房大小≤40 mm是增加使用NOAC机会的一个因素（OR 2.5，95%CI 1.1 - 5.8，p = 0.03）。
几乎所有住院的AF患者在血栓栓塞并发症的二级预防中都接受了OAC治疗。NOAC用于合并症较少的AF患者的卒中二级预防。
