Wu Yangxun, Liu Haiping, Qin Liu'an, Wang Yuyan, Zhang Shizhao, Wang Ziqian, Zou Yuting, Yin Tong
Institute of Geriatrics, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.
Front Cardiovasc Med. 2022 Jun 29;9:923684. doi: 10.3389/fcvm.2022.923684. eCollection 2022.
The efficacy and safety of antithrombotic treatment with oral anticoagulants (OACs) in elderly patients with comorbidities of acute coronary syndrome (ACS) and atrial fibrillation (AF) are unclear.
A cohort of hospitalized elderly patients (≥65 years of age) diagnosed with ACS and AF and treated with oral antithrombotic agents were consecutively recruited. Follow-up was performed for at least 1 year. Major adverse cardiac events (MACEs) were defined as a composite of all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, and systemic embolism. The safety outcomes of bleeding were defined according to the Bleeding Academic Research Consortium (BARC) criteria.
A cohort of 548 eligible patients (76 ± 6.6 years) was analyzed. Compared to the patients with OAC treatment ( = 184, 33.6%), patients treated without OAC ( = 364, 66.4%) were older, had a lower prevalence of persistent AF and unstable angina (UA), and more often presented with paroxysmal AF, acute myocardial infarction (AMI), stent implantation and dual antiplatelet therapy (DAPT). Compared to the patients without OAC treatment ( = 364, 66.4%), patients treated with OAC ( = 184, 33.6%) had a lower risk of MACEs at both the 1-year (4.3 vs. 15.1%, adjusted HR: 0.34, 95% CI: 0.15-0.80, = 0.014) and 5-year (17.5 vs. 48.4%, adjusted HR: 0.36, 95% CI: 0.19-0.67, = 0.001) follow-up. No significant difference was observed for bleeding events of BARC ≥2 between the groups (8.0 vs. 9.0%, adjusted HR: 1.17, 95% CI: 0.58-2.34, = 0.667). Compared with warfarin-treated patients, the non-vitamin K antagonist oral anticoagulant-treated patients had lower risks of all-cause mortality (2.1 vs. 9.5%, HR: 0.18, 95% CI: 0.03-0.98, = 0.047) and bleeding events of BARC ≥ 3 (2.1 vs. 4.8%, HR: 0.14, 95% CI: 0.02-1.10, = 0.062).
Antithrombotic therapy with OACs in elderly patients with ACS and AF was associated with a lower risk of ischemic events without an increase in bleeding events. In real-world practice, the clinical awareness of anticoagulation treatments in elderly patients with ACS and AF needs to be strengthened.
口服抗凝剂（OACs）用于合并急性冠状动脉综合征（ACS）和心房颤动（AF）的老年患者的抗血栓治疗的疗效和安全性尚不清楚。
连续纳入一组诊断为ACS和AF并接受口服抗血栓药物治疗的住院老年患者（≥65岁）。进行至少1年的随访。主要不良心脏事件（MACEs）定义为全因死亡、非致命性心肌梗死（MI）、非致命性卒中及系统性栓塞的复合事件。出血的安全性结局根据出血学术研究联盟（BARC）标准定义。
分析了一组548例符合条件的患者（76±6.6岁）。与接受OAC治疗的患者（n = 184，33.6%）相比，未接受OAC治疗的患者（n = 364，66.4%）年龄更大，持续性AF和不稳定型心绞痛（UA）的患病率更低，更常表现为阵发性AF、急性心肌梗死（AMI）、支架植入及双联抗血小板治疗（DAPT）。与未接受OAC治疗的患者（n = 364，66.4%）相比，接受OAC治疗的患者（n = 184，33.6%）在1年（4.3%对15.1%，调整后HR：0.34，95%CI：0.15 - 0.80，P = 0.014）和5年（17.5%对48.4%，调整后HR：0.36，95%CI：0.19 - 0.67，P = 0.001）随访时发生MACEs的风险更低。两组间BARC≥2级出血事件无显著差异（8.0%对9.0%，调整后HR：1.17，95%CI：0.58 - 2.34，P = 0.667）。与华法林治疗的患者相比，非维生素K拮抗剂口服抗凝剂治疗的患者全因死亡率（2.1%对9.5%，HR：0.18，95%CI：0.03 - 0.98，P = 0.047）和BARC≥3级出血事件（2.1%对4.8%，HR：0.14，95%CI：0.02 - 1.10，P = 0.062）风险更低。
OACs用于合并ACS和AF的老年患者的抗血栓治疗与缺血事件风险降低相关，且不增加出血事件。在实际临床实践中，需要加强对合并ACS和AF的老年患者抗凝治疗的临床认识。
