Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Jigozen 1-3-3, Hatsukaichi, Hiroshima, 738-8503, Japan.
Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan.
BMC Cardiovasc Disord. 2021 Sep 8;21(1):423. doi: 10.1186/s12872-021-02235-8.
This study sought to describe the epidemiology of anticoagulation therapy for critically ill patients with new-onset atrial fibrillation (NOAF) according to CHA2DS2-VASc and HAS-BLED scores and to assess the efficacy of early anticoagulation therapy.
Adult patients who developed NOAF during intensive care unit stay were included. We compared the patients who were treated with and without anticoagulation therapy within 48 h from AF onset. The primary outcome was a composite outcome that included mortality and ischemic stroke during the period until hospital discharge.
In total, 308 patients were included in this analysis. Anticoagulants were administered to 95 and 33 patients within 48 h and after 48 h from NOAF onset, respectively. After grouping the patients into four according to their CHA2DS2-VASc and HAS-BLED bleeding scores, we found that the proportion of anticoagulation therapy administered was similar among all groups. After adjustment using a multivariable Cox regression model, we noted that early anticoagulation therapy did not decrease the composite outcome (adjusted hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.47‒1.23). However, in patients without rhythm control drugs, early anticoagulation was significantly associated with better outcomes (adjusted HR 0.46; 95% CI; 0.22‒0.87, P = 0.041).
We found that clinical prediction scores were supposedly not used in the decision to implement anticoagulation therapy and that early anticoagulation therapy did not improve clinical outcomes in critically ill patients with NOAF. Trial registration UMIN-CTR UMIN000026401. Registered 5 March 2017.
本研究旨在根据 CHA2DS2-VASc 和 HAS-BLED 评分描述新发性心房颤动（NOAF）危重症患者抗凝治疗的流行病学，并评估早期抗凝治疗的疗效。
纳入入住重症监护病房期间发生 NOAF 的成年患者。我们比较了在 AF 发作后 48 小时内接受和未接受抗凝治疗的患者。主要结局是包括住院期间死亡和缺血性卒中的复合结局。
本分析共纳入 308 例患者。抗凝剂分别在 NOAF 发作后 48 小时内和 48 小时后给予 95 例和 33 例患者。根据 CHA2DS2-VASc 和 HAS-BLED 出血评分将患者分为四组后，我们发现所有组中抗凝治疗的比例相似。使用多变量 Cox 回归模型调整后，我们注意到早期抗凝治疗并未降低复合结局（调整后的危险比 [HR] 0.77；95%置信区间 [CI] 0.47-1.23）。然而，在未使用节律控制药物的患者中，早期抗凝治疗与更好的结局显著相关（调整后的 HR 0.46；95%CI：0.22-0.87，P=0.041）。
我们发现，临床预测评分似乎并未用于决定实施抗凝治疗，早期抗凝治疗并未改善 NOAF 危重症患者的临床结局。试验注册 UMIN-CTR UMIN000026401。于 2017 年 3 月 5 日注册。
