Chao Tze-Fan, Nedeljkovic Milan A, Lip Gregory Y H, Potpara Tatjana S
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
Eur Heart J Suppl. 2020 Dec 22;22(Suppl O):O53-O60. doi: 10.1093/eurheartj/suaa180. eCollection 2020 Dec.
Stroke prevention is one of the cornerstones of management in patients with atrial fibrillation (AF). As part of the ABC (Atrial fibrillation Better Care) pathway (A: Avoid stroke/Anticoagulation; B: Better symptom control; C: Cardiovascular risk and comorbidity optimisation), stroke risk assessment and appropriate thromboprophylaxis is emphasised. Various guidelines have addressed stroke prevention. In this review, we compared the 2017 APHRS, 2018 ACCP, 2019 ACC/AHA/HRS, and 2020 ESC AF guidelines regarding the stroke/bleeding risk assessment and recommendations about the use of OAC. We also aimed to highlight some unique points for each of those guidelines. All four guidelines recommend the use of the CHADS-VASc score for stroke risk assessment, and OAC (preferably NOACs in all NOAC-eligible patients) is recommended for AF patients with a CHA2DS2-VASc score ≥2 (males) or ≥3 (females). Guidelines also emphasize the importance of stroke risk reassessments at periodic intervals (e.g. 4-6 months) to inform treatment decisions (e.g. initiation of OAC in patients no longer at low risk of stroke) and address potentially modifiable bleeding risk factors.
预防中风是房颤（AF）患者管理的基石之一。作为ABC（更好的房颤护理）路径（A：避免中风/抗凝；B：更好地控制症状；C：优化心血管风险和合并症）的一部分，强调了中风风险评估和适当的血栓预防。各种指南都涉及中风预防。在本综述中，我们比较了2017年亚太心律学会（APHRS）、2018年美国胸科医师学会（ACCP）、2019年美国心脏病学会/美国心脏协会/心律学会（ACC/AHA/HRS）和2020年欧洲心脏病学会（ESC）房颤指南中关于中风/出血风险评估以及口服抗凝药（OAC）使用的建议。我们还旨在突出这些指南各自的一些独特之处。所有这四项指南都推荐使用CHADS-VASc评分进行中风风险评估，对于CHA2DS2-VASc评分≥2（男性）或≥3（女性）的房颤患者，推荐使用OAC（在所有符合条件的患者中，首选新型口服抗凝药）。指南还强调定期（如4 - 6个月）进行中风风险重新评估的重要性，以便为治疗决策提供依据（如在不再处于低中风风险的患者中启动OAC）并处理潜在可改变的出血风险因素。
