在心房导管切除后的口服抗凝药:益处和风险
Koshiro Kanaoka1,2, Taku Nishida2, Yoshitaka Iwanaga1,3
1Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan.
European heart journal
|December 20, 2023
概括
持续口服抗凝剂 (OAC) 治疗以导管切除 (CA) 治疗心房 (AF) 后,根据CHADS2得分显示出不同的风险和益处. 对于低风险患者来说,出血风险可能超过OAC延续导致的血栓栓塞减少.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 医疗信息学 医疗信息学
背景情况:
- 有限的大规模数据存在于口服抗凝剂 (OAC) 治疗延续在心房动 (AF) 的导管切除后 (CA).
- 评估与OAC持续相关的血栓栓塞和出血风险的平衡对于患者管理至关重要.
研究的目的:
- 评估AF的CA后OAC治疗延续率.
- 通过CHADS2分数分层分析OAC延续和随后的血栓栓塞和出血事件之间的关联.
主要方法:
- 日本全国行政索赔数据库的回顾性分析 (2014年4月至2021年3月).
- 包括接受非复发性AF的CA的患者,分为OAC延续组,CA后6个月.
- 应用治疗权重的逆概率 (IPTW) 进行结果分析.
主要成果:
- 在231374名患者中,71%的人在CA后6个月继续接受OAC治疗.
- 在低CHADS2评分 (≤1) 的患者中,OAC的延续与血栓栓塞缩小 (HR 0.61),但大出血增加 (HR 1.51).
- 在高CHADS2评分 (≥3) 的患者中,OAC持续治疗显著降低了血栓栓塞 (HR 0.61),但没有显著增加大出血 (HR 1.05).
结论:
- 在AF的CA后继续OAC治疗的好处和风险取决于CHADS2得分.
- 对于血栓塞栓风险较低的患者 (CHADS2得分较低),较大的出血风险增加可能会超过OAC延续的好处.
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