患有来自ANAFIE非膜心房的老年患者的功能和临床结果
Wataru Shimizu1, Takeshi Yamashita2, Masaharu Akao3
1Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
JACC. Asia
|July 3, 2023
概括
直接口服抗凝剂 (DOACs) 对患有非膜心房动和功能障碍的老年患者有效且安全. 随着功能下降,结果会恶化,但DOAC在中度功能障碍中显示出对华法林的好处.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 老年病的医生 老年病的医生
背景情况:
- 年龄增长,功能下降和心房动是常见的并发症.
- 有限的现实世界数据存在于直接口服抗凝剂 (DOAC) 在老年患者 (≥75岁) 的使用与非膜心房动和功能障碍.
研究的目的:
- 为了评估2年临床结果和抗凝剂治疗策略在老年患者与非膜心房动,分层由功能.
- 评估不同程度的功能障碍对该患者群体临床结果的影响.
主要方法:
- 来自ANAFIE注册表的26,202名患有非膜性心房的老年患者的分析,根据肌素清除率 (CrCl) 分为四个分层.
- 对中风/全身栓塞事件,重大出血和死亡率的累积发病率的评估.
- 多变量考克斯回归分析以确定临床结果的独立风险因素.
主要成果:
- 较高的中风,出血和死亡发病率与降低的CrCl.Cl.一起观察到.
- 较低的CrCl是大多数临床结果的独立风险因素,不包括大出血.
- 与瓦法林相比,DOAC在CrCl亚组 (≥15毫升/分钟) 中表现出类似或更高的有效性和安全性.
- 与华法林相比,DOAC使用与CrCl 30至<50毫升/分钟的患者中风,出血和死亡风险降低有关.
结论:
- 在患有非膜心肌的老年患者中,临床结果事件随着功能下降而升级.
- DOACs被证明是有效和安全的,即使在患有功能障碍的患者中 (CrCl 15-<50毫升/分钟).
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