Sjøholm-Christensen Andreas, Tojaga Nedim, Brandes Axel
Department of Cardiology, Esbjerg Hospital-University Hospital of Southern Denmark, Finsensgade 35, DK-6700 Esbjerg, Denmark.
Department of Regional Health Research, University of Southern Denmark, Finsensgade 35, DK-6700 Esbjerg, Denmark.
J Clin Med. 2024 Dec 27;14(1):82. doi: 10.3390/jcm14010082.
Clinical atrial fibrillation (AF) is a well-established major risk factor for stroke and systemic embolism. Pivotal trials have shown that treatment with oral anticoagulation reduces the risk of stroke and systemic embolism in clinical AF with a simultaneous increase in the risk of major bleeding. To help balance the risk of stroke and bleeding in clinical AF, different prediction models including biomarkers and clinical features have been validated. Device-detected AF (DDAF) is also associated with an increased risk of stroke and systemic embolism, but not to the same extent as clinical AF. Two large randomised studies have found significant stroke risk reduction with direct oral anticoagulation in DDAF patients, yet also a significantly increased risk of major bleeding. To date, the question remains how to balance the thromboembolic risk reduction with oral anticoagulation and the increased risk of bleeding in patients with DDAF and to identify the right patients who may benefit from oral anticoagulant treatment.
临床房颤（AF）是公认的导致中风和全身性栓塞的主要危险因素。关键试验表明，口服抗凝治疗可降低临床房颤患者中风和全身性栓塞的风险，同时大出血风险也会增加。为了帮助平衡临床房颤患者中风和出血的风险，包括生物标志物和临床特征在内的不同预测模型已得到验证。设备检测到的房颤（DDAF）也与中风和全身性栓塞风险增加相关，但程度不如临床房颤。两项大型随机研究发现，直接口服抗凝剂可显著降低DDAF患者的中风风险，但大出血风险也显著增加。迄今为止，如何平衡口服抗凝剂降低血栓栓塞风险与DDAF患者出血风险增加之间的关系，以及确定哪些患者可能从口服抗凝治疗中获益，仍是一个问题。
