老年患者心房高频发作:抗凝固治疗的困境
Lorenzo Pimpini1, Leonardo Biscetti2, Giulia Matacchione3
1Cardiology Unit, IRCCS INRCA, Via della Montagnola 81, 60127 Ancona, Italy.
Journal of clinical medicine
|June 27, 2024
概括
鉴定患有亚临床心房动 (SCAF) 的患者,他们最受益于抗凝药是具有挑战性的. 本综述提出了一个增强的风险评分,以个性化治疗SCAF患者,旨在优化中风预防.
科学领域:
- 心脏病学 心脏病学
- 老年病的医生 老年病的医生
- 药理学 药理学是指药理学的学科.
背景情况:
- 心房动 (AF) 增加了患病率和死亡率,特别是在老年人中.
- 亚临床心房动 (SCAF) 涉及通过心脏植入式电子设备 (CIED) 检测到心房高频发作 (AHREs).
- 在SCAF患者中,抗凝固药治疗具有复杂的风险-益处平衡,试验显示中风风险降低,但出血增加.
研究的目的:
- 审查当前关于识别SCAF患者的证据,这些患者从抗凝药中获得了最高的净临床益处.
- 提出改善AVS患者中风和全身栓塞风险分层的策略.
- 建议SCAF管理的个性化治疗方法.
主要方法:
- 关于SCAF中的抗凝固作用的现有证据的审查.
- 来自ARTESiA和NOAH-AFNET 6试验的元分析数据的分析.
- 提议改进预后得分,并纳入新的风险因素.
主要成果:
- 埃多克萨班或阿皮克萨班降低了~32%的中风风险,但在分析中增加了~62%的重大出血.
- 目前的风险评分可能无法充分识别SCAF患者的最佳抗凝效益.
- 建议的得分包括CKD,肥胖,左心房体积扩大,血压控制和虚弱.
结论:
- 个性化风险分层对于优化SCAF患者的抗凝血非常重要.
- 增强的CHA2DS2-VASc得分,结合新的参数,可能会改善患者的选择.
- 需要进一步的试验来验证个性化SCAF治疗的建议得分.
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