Department of Internal Medicine, Divisions of Geriatrics, Marmara University Medical School, Pendik, Istanbul, Turkey.
Eur Rev Med Pharmacol Sci. 2023 Apr;27(7):2919-2926. doi: 10.26355/eurrev_202304_31923.
This study aims to determine the effect of frailty on thromboembolic events (TEE) and bleeding in older patients with non-valvular atrial fibrillation (AF).
Patients aged ≥65 years who were diagnosed as having non-valvular AF in a geriatric outpatient clinic between June 2015 and February 2021 were included in the study. Frailty, the risk of thrombosis secondary to AF, and the risk of bleeding as a complication of AF treatment were evaluated using the FRAIL scale, and CHA2DS2-VASc and HAS-BLED scores, respectively.
Out of 83 patients included in the study, 72.3% were frail and 21.7% were pre-frail. TEE was observed in 14.5% (n=12) and bleeding was observed in 25.3% (n=21) of the patients. A total of 21 (25.3%) patients had a history of bleeding. There was no difference between the normal, pre-frail, and frail groups in terms of TEE and bleeding history (p=0.112 and p=0.571, respectively). In multivariate analysis, mortality decreased with the use of apixaban; frailty and malnutrition were found to increase mortality (p=0.014, p=0.023, and p=0.020, respectively). HAS-BLED-F score was obtained as a result of the sum of the patients' HAS-BLED and FRAIL scores to predict the bleeding risk. A HAS-BLED-F score of ≥6 predicted the risk of bleeding with 90.5% sensitivity and 40.3% specificity.
Frailty is not associated with a statistically significant increase in the risk of thromboembolic events or bleeding in patients with non-valvular AF. HAS-BLED-F score can be used to better predict the risk of bleeding in frail patients.
本研究旨在确定衰弱对老年非瓣膜性心房颤动（AF）患者血栓栓塞事件（TEE）和出血的影响。
本研究纳入了 2015 年 6 月至 2021 年 2 月在老年门诊被诊断为非瓣膜性 AF 的年龄≥65 岁的患者。使用 FRAIL 量表评估衰弱、AF 继发血栓形成风险和 AF 治疗相关出血风险，以及 CHA2DS2-VASc 和 HAS-BLED 评分。
在纳入的 83 例患者中，72.3%为衰弱，21.7%为衰弱前期。14.5%（n=12）患者发生 TEE，25.3%（n=21）患者发生出血。共有 21 例（25.3%）患者有出血史。在 TEE 和出血史方面，正常、衰弱前期和衰弱组之间无差异（p=0.112 和 p=0.571）。多变量分析显示，与华法林相比，使用阿哌沙班可降低死亡率；衰弱和营养不良与死亡率升高相关（p=0.014、p=0.023 和 p=0.020）。为了预测出血风险，将患者的 HAS-BLED 和 FRAIL 评分相加得出 HAS-BLED-F 评分。HAS-BLED-F 评分≥6 预测出血风险的敏感性为 90.5%，特异性为 40.3%。
衰弱与非瓣膜性 AF 患者血栓栓塞事件或出血风险的增加无统计学显著相关性。HAS-BLED-F 评分可用于更好地预测衰弱患者的出血风险。
