Silva Cunha Pedro, Viveiros Monteiro André, Coutinho Cruz Madalena, Malveiro Paula, Reis João Pedro, Portugal Guilherme, Dias Ana, Ferreira Rui Cruz, Oliveira Mário Martins
Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal.
Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal.
Geriatrics (Basel). 2022 Feb 17;7(1):20. doi: 10.3390/geriatrics7010020.
Atrial fibrillation (AF) is commonly associated with advanced age and the presence of multiple, concomitant acute and chronic health conditions, placing this population at high risk for serious therapeutic side effects. Nonvitamin K antagonist oral anticoagulants (NOACs) are increasingly used for stroke prevention in patients with atrial fibrillation. The purpose of this study was to investigate the effectiveness and safety of NOAC in a group at high risk of bleeding complications, in a real-world setting. We conducted a retrospective analysis of a high-risk cohort of 418 patients (pts) followed-up in our anticoagulation unit; data on patient characteristics, anticoagulation treatment, and bleeding and thrombotic complications were evaluated. The population had a median age of 77.8 ± 10.3 years and the mean CHADS-VASc score was 3.85 (SD ± 1.4). Overall, 289 (69.1%) were ≥75 years old. During a mean follow-up time of 51.2 ± 35.7 months, we observed a rate of any bleeding of 7, a clinically relevant non-major bleeding rate of 4.8, a major bleeding rate of 2.2, a stroke rate of 1.6, and a rate of thrombotic events of 0.28 per 100 patient-years. There were 59 hospitalizations due to any cause (14.1%) and 36 (8.6%) deaths (one due to ischemic stroke). A structured follow-up, with judicious prescribing and drug compliance, may contribute to preventing potential complications.
心房颤动（AF）通常与高龄以及多种急性和慢性健康状况并存有关，这使得该人群面临严重治疗副作用的高风险。非维生素K拮抗剂口服抗凝药（NOACs）越来越多地用于预防心房颤动患者的中风。本研究的目的是在真实世界环境中，调查NOAC在一组有出血并发症高风险人群中的有效性和安全性。我们对在我们抗凝科随访的418例高危患者队列进行了回顾性分析；评估了患者特征、抗凝治疗以及出血和血栓形成并发症的数据。该人群的中位年龄为77.8±10.3岁，平均CHADS-VASc评分为3.85（标准差±1.4）。总体而言，289例（69.1%）年龄≥75岁。在平均51.2±35.7个月的随访时间内，我们观察到每100患者年的任何出血发生率为7，临床相关非大出血发生率为4.8，大出血发生率为2.2，中风发生率为1.6，血栓形成事件发生率为0.28。因任何原因住院59例（14.1%），死亡36例（8.6%）（1例死于缺血性中风）。进行结构化随访，合理用药并确保药物依从性，可能有助于预防潜在并发症。
