Kinjo Norito, Ueda Shinichiro, Uchida Kazutaka, Sakakibara Fumihiro, Nezu Mari, Arai Hideki, Morimoto Takeshi
Department of Clinical Epidemiology Hyogo Medical University Nishinomiya Japan.
Department of Neurosurgery Hyogo Medical University Nishinomiya Japan.
J Arrhythm. 2023 Jun 16;39(4):556-565. doi: 10.1002/joa3.12885. eCollection 2023 Aug.
Anemia is encountered in patients with nonvalvular atrial fibrillation (NVAF) on oral anticoagulants (OACs) but the prognostic impact was not well scrutinized in real-world settings.
We conducted a historical multicenter registry of patients with NVAF taking OACs at 71 centers in Japan. Those with mechanical heart valves or a history of pulmonary thrombosis or deep venous thrombosis were excluded. Anemic patients were divided into three groups of hemoglobin (Hb) level: moderate/severe (Hb < 11.0 g/dL), mild (men: Hb of 11.0-12.9 g/dL; women: Hb of 11.0-11.9 g/dL), and no anemia. The endpoints included major bleeding, hemorrhagic stroke, ischemic events, ischemic stroke, and all-cause mortality.
Among 7558 consecutive patients (mean age, 73 years; men 67%) registered in February 2013 and followed until February 2017, 2100 (28%) patients had anemia. The anemic patients were older (moderate/severe: 79 years; mild: 77 years; no anemia: 71 years, < .001), and HAS-BLED score was significantly higher in the anemic patients ( < .001). The cumulative incidences at 4 years of major bleeding in moderate/severe, mild, and no anemia group, were 14.9%, 10.7%, and 6.4%, respectively. The adjusted hazard ratios (HRs) (95% confidential intervals (CIs)) of major bleeding of moderate/severe and mild anemia group were 1.96 (1.49-2.58) and 1.48 (1.17-1.87) compared to no anemia group. The adjusted HRs (95% CIs) for ischemic events were 0.63 (0.39-0.99) and 1.03 (0.76-1.39).
The severity of anemia in the patients with NVAF on OACs was associated with major bleeding.
口服抗凝药（OAC）治疗的非瓣膜性心房颤动（NVAF）患者中会出现贫血，但在现实环境中其预后影响尚未得到充分审视。
我们对日本71个中心接受OAC治疗的NVAF患者进行了一项历史性多中心登记研究。排除有机械心脏瓣膜或有肺血栓或深静脉血栓病史的患者。贫血患者根据血红蛋白（Hb）水平分为三组：中度/重度（Hb < 11.0 g/dL）、轻度（男性：Hb为11.0 - 12.9 g/dL；女性：Hb为11.0 - 11.9 g/dL）和无贫血。终点包括大出血、出血性卒中、缺血性事件、缺血性卒中和全因死亡率。
在2013年2月登记并随访至2017年2月的7558例连续患者（平均年龄73岁；男性67%）中，2100例（28%）患者有贫血。贫血患者年龄更大（中度/重度：79岁；轻度：77岁；无贫血：71岁，P <.001），且贫血患者的HAS - BLED评分显著更高（P <.001）。中度/重度、轻度和无贫血组4年时大出血的累积发生率分别为14.9%、10.7%和6.4%。与无贫血组相比，中度/重度和轻度贫血组大出血的调整后风险比（HR）（95%置信区间（CI））分别为1.96（1.49 - 2.58）和1.48（1.17 - 1.87）。缺血性事件的调整后HR（95% CI）分别为0.63（0.39 - 0.99）和1.03（0.76 - 1.39）。
接受OAC治疗的NVAF患者贫血的严重程度与大出血相关。
