Ehrlinder Hanne, Orsini Nicola, Modig Karin, Wallén Håkan, Gigante Bruna
Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital Karolinska Institutet Stockholm Sweden.
Department of Public Health Sciences Karolinska Institutet Stockholm Sweden.
Res Pract Thromb Haemost. 2022 Oct 25;6(7):e12823. doi: 10.1002/rth2.12823. eCollection 2022 Oct.
Risks of antithrombotic switching is not investigated in elderly atrial fibrillation patients.
To investigate the effectiveness and safety of antithrombotic treatment and switching of antithrombotic treatment in elderly patients (aged 75 years or older) with atrial fibrillation (AF).
We conducted a cohort study of 2943 patients with AF (Carrebean-elderly), hospitalized during 2010-2017. Cox models were used to estimate the association of antithrombotic treatment (warfarin, direct oral anticoagulants [DOAC] and non-guideline-recommended therapy [NG], i.e., aspirin and low-molecular-weight heparin) at discharge and antithrombotic treatment switching during follow-up with the risk of a composite and single end points of thromboembolism, bleeding, and cardiac death. Crude and adjusted risk estimates were expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). All-cause death was evaluated, with competing risk regression and estimates expressed as subhazard ratios and 95% CIs.
We observed an increased risk for the composite end point associated with NG as compared to warfarin at discharge (HR, 1.18; 95% CI, 1.01-1.38) with congruent competing risk regression results, while no significant risk difference was seen for DOACs compared to warfarin (HR, 1.12; 95% CI, 0.92-1.36). Switching from NG to warfarin/DOAC and from warfarin to DOAC occurred in 30.4% and 33.1% of respective antithrombotic treatment groups at discharge and was associated with a decreased risk for the composite end point with an adjusted HR of 0.45 (95% CI, 0.32-0.63) and a HR of 0.50 (95% CI, 0.38-0.65), respectively.
Antithrombotic treatment switching is common in the elderly AF population. Importantly, switching to guideline-recommended treatment has a favorable impact on both effectiveness and safety.
老年房颤患者抗栓治疗转换的风险尚未得到研究。
探讨老年（75岁及以上）房颤（AF）患者抗栓治疗及抗栓治疗转换的有效性和安全性。
我们对2010 - 2017年期间住院的2943例房颤患者（加勒比地区老年人）进行了一项队列研究。采用Cox模型评估出院时抗栓治疗（华法林、直接口服抗凝剂[DOAC]和非指南推荐治疗[NG]，即阿司匹林和低分子肝素）以及随访期间抗栓治疗转换与血栓栓塞、出血和心源性死亡的复合及单一终点风险之间的关联。粗风险估计和调整后的风险估计以风险比（HR）及其95%置信区间（CI）表示。采用竞争风险回归评估全因死亡，并以亚风险比和95%CI表示估计值。
我们观察到，出院时与华法林相比，NG与复合终点风险增加相关（HR，1.18；95%CI，1.01 - 1.38），竞争风险回归结果一致，而与华法林相比，DOACs未观察到显著风险差异（HR，1.12；95%CI，0.92 - 1.36）。出院时，分别有30.4%和33.1%的抗栓治疗组从NG转换为华法林/DOAC以及从华法林转换为DOAC，这与复合终点风险降低相关，调整后的HR分别为0.45（95%CI，0.32 - 0.63）和HR为0.50（95%CI，0.38 - 0.65）。
抗栓治疗转换在老年房颤人群中很常见。重要的是，转换为指南推荐的治疗对有效性和安全性均有有利影响。
