左心室附属体封闭与口服抗凝药的有效性
Emily P Zeitler1,2, Stephen Kearing1, Megan Coylewright3
1Dartmouth Health (E.P.Z., S.K.), Lebanon, NH.
Circulation
|February 13, 2023
概括
与抗凝药相比,左心房塞 (LAAO) 显著降低了老年心房患者的死亡率和中风风险. 对于女性和男性来说,LAAO的长期出血风险也较低.
科学领域:
- 心脏病学
- 医疗器械
- 健康成果研究
背景情况:
- 老年心房 (AF) 患者接受抗凝治疗与左心房塞 (LAAO) 的现实结果可能与临床试验不同.
- 包括性别在内的患者人口统计和抗凝血策略可能会影响结果.
研究的目的:
- 根据性别分类,比较使用LAAO治疗的老年AF患者和使用抗凝剂治疗的老年AF患者的实际结果.
- 在这些患者群体中评估死亡,中风或全身栓塞和出血的风险.
主要方法:
- 2015年至2019年使用的医疗保险索赔数据.
- 将LAAO接受者与单抗凝血患者进行1:1匹配,使用倾向性得分匹配,创建性别特定的子组.
- 使用Cox比例危险模型比较死亡率,中风/全身栓塞和出血的风险.
主要成果:
- 与抗凝药相比,LAAO显著降低了女性 (HR,0. 509) 和男性 (HR,0. 541) 的死亡风险.
- 对于女性 (HR,0. 655) 和男性 (HR,0. 649) 来说,LAAO的中风或全身栓塞风险也显著降低.
- 在两种性别中,LAAO显示出早期出血风险增加,但在6周后长期出血风险降低.
结论:
- 在老年医疗保险受益者中,与实际数据相比,LAAO显示死亡,中风和长期出血的风险降低.
- 这些发现支持LAAO作为抗凝血药物可行的替代药物,用于降低AF中风风险.
- 结果应该为考虑AF中风预防策略的患者提供共享决策.
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