Bielecka B, Gorczyca I, Jelonek O, Wożakowska-Kapłon B
1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Center, Kielce 25-736, Poland.
Collegium Medicum, The Jan Kochanowski University, Kielce 25-369, Poland.
Cardiol Res Pract. 2021 Feb 8;2021:6657776. doi: 10.1155/2021/6657776. eCollection 2021.
In recent years, significant changes in stroke prophylaxis in patients with atrial fibrillation (AF) have been observed. Non-vitamin K antagonist oral anticoagulants (NOACs) are more commonly used in the prevention of thromboembolic complications in patients with AF. The aim of the study was to evaluate recommended stroke prophylaxis in patients with AF and to identify predictors of using NOACs in patients treated with anticoagulant therapy. The present study was a retrospective, observational, single-center study which included consecutively hospitalized patients in the reference cardiology center from January 2014 to December 2018. In the study group of 4027 patients with AF, to prevent thromboembolic complications, OACs were used in 3680 patients (91.4%), an antiplatelet drug(s) was used in 124 patients (3.1%), and 223 patients (5.5%) did not undergo any thromboembolic event prevention. In the group of 3680 patients treated with OACs, 2311 patients (62.8%) received NOACs and 1639 patients (37.2%), VKAs. Independent predictors of the use of NOACs were age (OR, 1.02; 95% CI, 1.01-1.03; < 0.001), a previous thromboembolic event (OR, 1.29; 95% CI, 1.01-1.65; =0.04), nonpermanent AF (OR, 1.61; 95% CI, 1.34-1.93; < 0.001), and eGFR (OR, 1.22; 95% CI, 1.02-1.46; =0.03). Between 2014 and 2018, an increase of patients treated with OACs, mainly with NOACs, was observed. Age, past thromboembolic complications, nonpermanent AF, and preserved renal function determined the choice of NOACs.
近年来，已观察到心房颤动（AF）患者的卒中预防发生了显著变化。非维生素K拮抗剂口服抗凝药（NOACs）在预防AF患者血栓栓塞并发症方面的使用更为普遍。本研究的目的是评估AF患者推荐的卒中预防措施，并确定接受抗凝治疗的患者使用NOACs的预测因素。本研究是一项回顾性、观察性、单中心研究，纳入了2014年1月至2018年12月在参考心脏病中心连续住院的患者。在4027例AF患者的研究组中，为预防血栓栓塞并发症，3680例患者（91.4%）使用了口服抗凝药（OACs），124例患者（3.1%）使用了抗血小板药物，223例患者（5.5%）未采取任何血栓栓塞事件预防措施。在3680例接受OACs治疗的患者中，2311例患者（62.8%）接受了NOACs，1639例患者（37.2%）接受了维生素K拮抗剂（VKAs）。使用NOACs的独立预测因素为年龄（比值比[OR]，1.02；95%置信区间[CI]，1.01 - 1.03；P < 0.001）、既往血栓栓塞事件（OR，1.29；95% CI，1.01 - 1.65；P = 0.04）、非永久性AF（OR，1.61；95% CI，1.34 - 1.93；P < 0.001）和估算肾小球滤过率（eGFR）（OR，1.22；95% CI，1.02 - 1.46；P = 0.03）。2014年至2018年期间，观察到接受OACs治疗的患者增加，主要是接受NOACs治疗的患者。年龄、既往血栓栓塞并发症、非永久性AF和保留的肾功能决定了NOACs的选择。
