根据口服抗凝药状态,临床复杂的心房的老年患者的不良反应
Tommaso Bucci1,2, Giulio Francesco Romiti1,3, Hironori Ishiguchi1,4
1Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, United Kingdom.
EClinicalMedicine
|December 17, 2024
概括
在临床复杂性的老年心房患者中,停止服用口服抗凝剂会增加死亡和主要心血管事件的风险. 对这种脆弱人群来说,仔细考虑抗血栓策略至关重要.
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:
- 关于口服抗凝剂 (OAC) 对心房 (AF) 和临床复杂性 (CC) 患者的影响的数据有限.
- 了解OAC对这一群体的影响对于优化治疗策略至关重要.
- 患有AF和CC的老年患者是高风险群体,需要谨慎管理.
研究的目的:
- 评估停止OAC治疗对CC老年AF患者不良事件的影响.
- 为了比较OAC维持和停止组之间的死亡,主要心血管事件 (MACE) 和重大出血的风险.
- 确定对新型抗血栓和综合护理方法的需求.
主要方法:
- 使用TriNetX网络 (2020-2022) 的回顾性研究.
- 包括75岁以上的AF患者与CC (低BMI,出血史或CKD) 在长期OAC.
- 使用考克斯回归和倾向分数匹配 (PSM) 的OAC维持和停止组之间的比较结果 (所有原因死亡,MACE,大出血).
主要成果:
- 在AFCC患者中OAC的中止与PSM后所有死因 (HR 1.22) 和MACE (HR 1.38) 的风险增加有关.
- 在两组之间,大出血的一年风险是相似的,但在停止治疗后的早期更高 (HR 1.51).
- 主要结局的风险随着时间的推移而降低,出血风险变得不显著.
结论:
- 在临床复杂性的老年AF患者中停止OAC导致不良事件的高风险.
- 迫切需要新的抗血栓策略和综合护理,以减轻血栓风险而不增加出血风险.
- 在这种复杂的人群中优化OAC管理对于改善患者的治疗结果至关重要.
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