Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA.
Am Heart J. 2021 Feb;232:1-9. doi: 10.1016/j.ahj.2020.10.056. Epub 2020 Oct 24.
Patients with atrial fibrillation (AF) who have undergone mitral valve repair are at risk for thromboembolic strokes. Prior to 2019, only vitamin K antagonists were recommended for patients with AF who had undergone mitral valve repair despite the introduction of direct oral anticoagulants (DOAC) in 2010.
To characterize the use of anticoagulants in patients with AF who underwent surgical mitral valve repair (sMVR) or transcatheter mitral valve repair (tMVR).
We performed a retrospective cohort analysis of patients with AF undergoing sMVR or tMVR between 04/2014 and 12/2018 using Optum's de-identified Clinformatics® Data Mart Database. We identified anticoagulants prescribed within 90 days of discharge from hospitalization.
Overall, 1997 patients with AF underwent valve repair: 1560 underwent sMVR, and 437 underwent tMVR. The mean CHADS-VASc score among all patients was 4.1 (SD 1.9). The overall use of anticoagulation was unchanged between 2014 (72.2%) and 2018 (70.0%) (P = .49). Among patients who underwent sMVR or tMVR between April 2014 and December 2018, the use of VKA therapy decreased from 62.9% to 32.1% (P < .01 for trend) and the use of DOACs increased from 12.4% to 37.3% (P < .01 for trend).
Among patients with AF who underwent sMVR or tMVR between 2014 and 2018, roughly 30% of patients were not treated with any anticoagulant within 90 days of discharge, despite an elevated stroke risk in the cohort. The rate of DOAC use increased steadily over the study period but did not significantly increase the rate of overall anticoagulant use in this high-risk cohort.
接受二尖瓣修复术的心房颤动（AF）患者有发生血栓栓塞性中风的风险。尽管在 2010 年推出了直接口服抗凝剂（DOAC），但在此之前，2019 年之前，仅推荐 AF 合并二尖瓣修复术的患者使用维生素 K 拮抗剂。
描述接受外科二尖瓣修复术（sMVR）或经导管二尖瓣修复术（tMVR）的 AF 患者使用抗凝剂的情况。
我们对 2014 年 4 月至 2018 年 12 月期间接受 sMVR 或 tMVR 的 AF 患者进行了回顾性队列分析，使用 Optum 的匿名 Clinformatics®Data Mart 数据库。我们确定了出院后 90 天内开具的抗凝药物。
总体而言，1997 例 AF 患者接受了瓣膜修复术：1560 例行 sMVR，437 例行 tMVR。所有患者的平均 CHADS-VASc 评分为 4.1（标准差 1.9）。2014 年（72.2%）和 2018 年（70.0%）之间抗凝治疗的总体使用率没有变化（P=0.49）。在 2014 年 4 月至 2018 年 12 月期间接受 sMVR 或 tMVR 的患者中，VKA 治疗的使用率从 62.9%降至 32.1%（趋势 P<0.01），DOAC 的使用率从 12.4%增至 37.3%（趋势 P<0.01）。
在 2014 年至 2018 年期间接受 sMVR 或 tMVR 的 AF 患者中，约 30%的患者出院后 90 天内未接受任何抗凝治疗，尽管该队列中风风险较高。在此高危人群中，DOAC 的使用率稳步上升，但并未显著增加总体抗凝治疗的使用率。
