Krittayaphong Rungroj, Winijkul Arjbordin, Wongtheptien Wattana, Wongvipaporn Chaiyasith, Wisaratapong Treechada, Kunjara-Na-Ayudhya Rapeephon, Boonyaratvej Smonporn, Kaewcomdee Pontawee, Yindeengam Ahthit
Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand.
J Geriatr Cardiol. 2020 Apr;17(4):184-192. doi: 10.11909/j.issn.1671-5411.2020.04.001.
To compare clinical outcomes between patients with and without history of major bleeding according to types of antithrombotic medications in patients with non-valvular atrial fibrillation (NVAF).
We conducted a multicenter registry of patients with NVAF during 2014 to 2017 in Thailand. The following data were collected: demographic data, type of NVAF, medical illness, components of CHADS-VASc and HAS-BLED scores, history of bleeding and severity, investigations, and antithrombotic medications. Clinical outcomes were death, bleeding, and ischemic stroke/transient ischemic attack (TIA).
There were a total of 3218 patients. The average age was 67.3 ± 11.3 years, and 58.3% were men. Sixty-nine patients (2.14%) had a history of major bleeding. Antithrombotic use was, as follows: 2126 patients (75.3%) received oral anticoagulant (OAC) alone, 555 (17.2%) received antiplatelet alone, 298 (9.3%) received both, and 239 (7.4%) received neither. During follow-up, 9.9% had major adverse outcomes, including death (5.9%), ischemic stroke/TIA (2.5%), and major bleeding (4.0%). There were no significant differences in the types of antithrombotic medications between patients with and without history of major bleeding. Multivariate analysis revealed old age, low body mass index, hypertension, diabetes, heart failure, and history of major bleeding to be independently associated with major adverse outcome. Adverse events significantly increased in patients with OAC plus antiplatelet.
History of major bleeding was identified as a factor that significantly affects clinical outcome. Inappropriate use of OAC plus antiplatelet should be avoided. Special caution should be made in this high-risk patients.
根据非瓣膜性心房颤动（NVAF）患者使用的抗血栓药物类型，比较有或无大出血病史患者的临床结局。
我们于2014年至2017年在泰国进行了一项NVAF患者的多中心登记研究。收集了以下数据：人口统计学数据、NVAF类型、疾病、CHADS-VASc和HAS-BLED评分的组成部分、出血病史及严重程度、检查结果和抗血栓药物。临床结局包括死亡、出血和缺血性中风/短暂性脑缺血发作（TIA）。
共有3218例患者。平均年龄为67.3±11.3岁，男性占58.3%。69例患者（2.14%）有大出血病史。抗血栓药物的使用情况如下：2126例患者（75.3%）仅接受口服抗凝药（OAC），555例（17.2%）仅接受抗血小板药物，298例（9.3%）两者都接受，239例（7.4%）两者都未接受。在随访期间，9.9%的患者出现主要不良结局，包括死亡（5.9%）、缺血性中风/TIA（2.5%）和大出血（4.0%）。有或无大出血病史的患者在抗血栓药物类型上无显著差异。多因素分析显示，老年、低体重指数、高血压、糖尿病、心力衰竭和大出血病史与主要不良结局独立相关。使用OAC加抗血小板药物的患者不良事件显著增加。
大出血病史被确定为显著影响临床结局的一个因素。应避免不适当使用OAC加抗血小板药物。对于这类高危患者应格外谨慎。
