在患有心房的老年患者中使用口服抗凝药:全国性队列研究
Tze-Fan Chao1,2, Chia-Jen Liu3,4, Yenn-Jiang Lin1,2
1Division of Cardiology (T.-F.C., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., T.-C.T., J.-N.L., F.-P.C., S.-A.C.).
Circulation
|March 2, 2018
概括
口服抗凝剂 (OAC) 降低了90岁以上心房患者的中风风险. 华法林显示有好处,而NOAC在老年人群中降低了内出血的风险.
科学领域:
- 心脏病学
- 老年病学
- 药理学
背景情况:
- 对心房的治疗依赖于口服抗凝剂 (OAC) 预防中风.
- 关于90岁及以上患者使用OAC和结果的数据有限.
研究的目的:
- 研究缺血性中风和内出血 (ICH) 的风险.
- 评估OAC治疗非常老年AF患者 (≥90岁) 的临床益处.
主要方法:
- 台湾国家医疗保险研究数据库 (1996-2015) 的回顾性分析.
- 在AF和非AF患者之间比较中风和ICH风险 (≥90岁).
- 在AF患者中分析了OAC (华法林,NOAC) 使用与不治疗或抗血小板药物.
主要成果:
- 与非肌痛性脑膜炎患者相比,肌痛性脑膜炎患者 (≥90) 的缺血性脑卒中风险较高 (HR1.93),但ICH风险相似.
- 在AF患者中使用华法林降低了中风风险 (HR 0. 69),并带来了积极的临床益处.
- 与华法林相比,NOAC显示ICH风险显著降低 (HR为0. 32).
结论:
- 华法林在极老的AF患者中提供了预防中风的净临床益处 (≥90).
- 与华法林相比,NOAC与内出血的风险较低.
- 在这种高风险老年人群中,OAC,特别是NOAC是推用于血栓预防的.
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