Background Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. The study examines the situation of antithrombotic therapy in elderly patients(more than 60 years old) with non-valvular atrial fibrillation(NVAF) and acute coronary syndrome(ACS) / percutaneous coronary intervention(PCI).Methods This study enrolled 381 elderly patients [mean age(69.95 ± 8.41) years; 289 males, 92 females]with NVAF and ACS / PCI between January 2006 and September 2013. According to clinical data, these patients were categorized into 4 groups: triple therapy(TT) group, dual antiplatelet therapy(DAT) group,vitamin K antagonist(VKA) plus single antiplatelet therapy(SAT) group and VKA group. According to score of CHA2DS2-VASc and HAS-BLED, all the patients were divided into 4 combinations. Statistical methods were used to analyze the situation of antithrombotic therapy and potential associations between the different combinations. Results 38 patients(9.97%) received TT and 300 patients(78.74%) received DAT. TT was received in 20 patients with CHA2DS2-VASc ≥2 and HAS-BLED ≥3, and 16 patients with CHA2DS2-VASc≥2 and HAS-BLED 3. Conclusions Elderly patients who suffered NVAF and ACS / PCI were with high risk of stroke and low risk of bleeding. Majority of these patients received DAT instead of TT. 相似文献
Risk stratification schemes assessing stroke and thromboembolism (stroke/TE) and bleeding relating to atrial fibrillation (AF) have largely been derived and validated in Western populations. We assessed risk factors that constitute scores for assessing stroke/TE (CHADS2, CHA2DS2-VASc) and bleeding (HAS-BLED), and the predictive value of these scores in a large cohort of Chinese patients with AF.
Methods and results
We studied 1034 AF patients (27.1% female, median age 75; 85.6% non-anticoagulated) with mean follow-up of 1.9 years. On multivariate analysis, vascular disease was independently associated with stroke/TE in non-anticoagulated patients (p = 0.04). In patients with a CHADS2 or CHA2DS2-VASc score = 1, the rate of stroke/TE was 2.9% and 0.9% respectively, but in patients at “high risk” (scores ≥ 2), this rate was 4.6% and 4.5%, respectively. The c-statistics for predicting stroke/TE with CHADS2 and CHA2DS2-VASc were 0.58 (p = 0.109) and 0.72 (p < 0.001), respectively. Compared to CHADS2, the use of CHA2DS2-VASc would result in a Net Reclassification Improvement (NRI) of 16.6% (p = 0.009) and an Integrated Discrimination Improvement (IDI) of 1.1% (p = 0.002). Cumulative survival of the patients with a CHA2DS2-VASc score ≥ 2 was decreased compared to those with a CHA2DS2-VASc score 0–1 (p < 0.001), but the CHADS2 was not predictive of mortality. There was an increased risk of major bleeding with increasing HAS-BLED score (c-statistic 0.61, 95% CI: 0.51–0.71, p = 0.042).
Conclusions
Vascular disease was a strong independent predictor of stroke/TE in Chinese patients with AF. The CHA2DS2-VASc score performed better than CHADS2 in predicting stroke/TE in this Chinese AF population. Cumulative survival of the patients at high risk with the CHA2DS2-VASc score (but not using CHADS2) was significantly decreased. 相似文献
BACKGROUND: Elevated coagulative molecular markers could reflect the prothrombotic state in the cardiovascular system of patients with non-valvular atrial fibrillation (NVAF). A prospective, cooperative study was conducted to determine whether levels of coagulative markers alone or in combination with clinical risk factors could predict subsequent thromboembolic events in patients with NVAF. METHODS: Coagulative markers of prothrombin fragment 1+2, D-dimer, platelet factor 4, and beta-thromboglobulin were determined at the enrollment in the prospective study. RESULTS: Of 509 patients with NVAF (mean age, 66.6 +/- 10.3 years), 263 patients were treated with warfarin (mean international normalized ratio, 1.86), and 163 patients, with antiplatelet drugs. During an average follow-up period of 2.0 years, 31 thromboembolic events occurred. Event-free survival was significantly better in patients with D-dimer level < 150 ng/ml than in those with D-dimer level>or==150 ng/ml. Other coagulative markers, however, did not predict thromboembolic events. Age (>or==75 years), cardiomyopathies, and prior stroke or transient ischemic attack were independent, clinical risk factors for thromboembolism. Thromboembolic risk in patients without the clinical risk factors was quite low (0.7%/year) when D-dimer was < 150 ng/ml, but not low (3.8%/year) when D-dimer was >or==150 ng/ml. It was >5%/year in patients with the risk factors regardless of D-dimer levels. This was also true when analyses were confined to patients treated with warfarin. CONCLUSIONS: D-dimer level in combination with clinical risk factors could effectively predict subsequent thromboembolic events in patients with NVAF even when treated with warfarin. 相似文献
The occurrence of disabling stroke, the major fatal consequence of atrial fibrillation, can be reduced by almost two-thirds with warfarin oral anticoagulation. Recent estimates on the prevalence of atrial fibrillation in the USA suggest that approximately 3 million people suffer from this common cardiac arrhythmia, therefore, the socioeconomic impact of adequate oral anticoagulation is enormous. Rivaroxaban, a direct orally available factor Xa inhibitor, is the first of a new class of drugs that target a central factor of the coagulation cascade upstream of thrombin. In the ROCKET AF clinical trial, rivaroxaban demonstrated noninferiority compared with warfarin for stroke prevention in patients with atrial fibrillation, while intracranial and fatal bleeding occurred less frequently with rivaroxaban treatment. Rivaroxban has recently been approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation by the US FDA and EMA. Very recently, rivaroxaban in addition to dual antiplatelet therapy, was shown to reduce mortality in patients with a recent acute coronary syndrome in the ATLAS ACS 2-TIMI 51 clinical trial. The clinical evaluation of rivaroxaban in cardiovascular disease and the results of the ROCKET AF study, the landmark clinical trial of rivaroxaban for stroke prevention, are discussed along with the unique pharmacological profile of rivaroxaban. 相似文献
Background Amiodarone has been shown to be safe in patients with acute myocardial infarction (AMI) who are at risk for sudden cardiac death. However, there is limited data concerning the safety of amiodarone in patients who experience AMI complicated by atrial fibrillation. Methods To determine the safety of amiodarone therapy, we conducted a retrospective analysis of elderly patients hospitalized with AMI who experienced atrial fibrillation and had survived to hospital discharge (n = 17,597). Amiodarone prescribed at discharge was evaluated for its association with short-term and long-term mortality in crude and adjusted analyses employing propensity score methods. Results Of the 17,597 patients, 550 patients (3.1%) were prescribed amiodarone, 2317 patients (13.2%) were prescribed other antiarrhythmic agents (excluded from analysis), and 14,730 (83.7%) were prescribed no antiarrhythmic medication at discharge. Thirty-day mortality rates were similar for patients prescribed amiodarone and those not prescribed amiodarone (6.8% amiodarone vs 5.4% no amiodarone, P = .21), but mortality at 1 year was higher among patients prescribed amiodarone (35.6% vs 31.6%, P = .001). However, amiodarone was not associated with mortality at 30 days (odds ratio 0.80, 95% CI 0.53-1.20) or at long-term follow-up (mean duration 612 days, hazard ratio 1.04, 95% CI 0.92-1.18) after multivariable modeling. Conclusions Amiodarone was not independently associated with short-term or long-term mortality in elderly patients discharged after a hospitalization for AMI complicated by atrial fibrillation. Although our data suggest that amiodarone may be safe to use in this population, randomized controlled trial data are needed to confirm this finding. (Am Heart J 2002;144:1095-101.) 相似文献
We studied clinically relevant haemorrhagic and thromboembolic events in 213 patients with atrial fibrillation (AF) during 818 patient-years of anticoagulant (AC) treatment. The incidence of complicating events per 100 patient-years of treatment in three groups of patients, those with mitral valve disease (MVD; n = 34), without MVD (n = 102) and those with previous thromboembolism (TE; n = 77) was: major peripheral haemorrhages 3.1, 3.3 and 8.2 (non-MVD vs. TE group, P less than 0.05), cerebrovascular events 3.9, 3.0 and 3.0 (NS), and peripheral arterial thromboembolism 0, 0 and 1.5 (non-MVD vs. TE group, P less than 0.05). The proportion of thrombotest values less than 5 and/or greater than 20% at regular check-ups was 9.8% in patients with and 6.9% in patients without major peripheral haemorrhages (P less than 0.01). Major peripheral haemorrhages are frequent in patients with AF receiving AC treatment. They are most likely to occur in those with previous thromboembolism and among those with unstable AC control. 相似文献
