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器具で検出された心房細動後の抗凝固薬の処方と結果の実践の変動
Alexander C Perino1,2, Jun Fan2, Mariam Askari2
1Department of Medicine, Stanford University School of Medicine, CA (A.C.P., P.A.H., M.P.T.).
Circulation
|March 19, 2019
まとめ
経口抗凝固薬 (OAC) は,脳卒中リスクの減少と関連しているにもかかわらず,デバイスで検出された心房細動 (AF) の治療にはあまり使われていません. 特に24時間以上のAF負荷は,OACで最も強い脳卒中減少を示しました.
科学分野:
- 心臓病科
- 医療機器
- 公衆衛生
背景:
- 器具で検出された心房細動 (AF) は脳卒中リスクを高めますが,心房細動の負担に基づいて口腔抗凝固薬 (OAC) を開始するための明確なガイドラインはありません.
- 装置で検出されたAFの後にOACの処方パターンを理解することは,脳卒中の予防戦略を最適化するために不可欠です.
研究 の 目的:
- 新しい装置で検出されたAFの後にOACの処方慣行の変化を調査する.
- AF負荷の異なる値におけるOAC開始と脳卒中リスクとの関連を検証する.
主な方法:
- 退役軍人の健康管理局のデータをリモートモニタリングで利用した遡及コホート研究.
- 心臓インプラント可能な電子機器とAF負担データ (2011年−2014年) を含む.
- AFの検出から90日以内にOACの処方箋を分析し,コックス回帰を用いて脳卒中との関連を分析した.
主要な成果:
- デバイスで検出されたAFは一般的であり,かなりの割合の患者で著しいAF負担が観察されました.
- OACの処方率は,AFの負担とともに増加したが,全体的に低いままだった (13%は> 6分から27%は> 24時間).
- AFの24時間後のOAC開始は,脳卒中リスクの有意な減少と関連していました.
結論:
- デバイスで検出されたAFは心臓に埋め込み可能な電子機器を持つ退役軍人の間で一般的です.
- 長期にわたるAFエピソードでも,OACの開始において,一般的な治療率は低い.
- 装置で検出されたAFにおけるOACの脳卒中軽減効果を確認するために,さらなるランダム化試験が必要である.
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