心房颤动患者口服新型抗凝药的获益与风险

新近问世的新型口服抗凝药如:达比加群、利伐沙班(拜瑞妥)、阿派沙班等,为心房颤动患者提供了除华法林的新选择。但由于使用时间较短,某些药理学作用不十分明确,其获益和风险尚需进一步评估。     

左心耳封堵术和口服抗凝药在非瓣膜性心房颤动中的有效性和安全性的Meta分析

目的 评估左心耳封堵术和口服抗凝药在非瓣膜性心房颤动(房颤)患者中的有效性和安全性.方法 通过检索Pubmed、EMBASE、Cochrane数据库中关于左心耳封堵术治疗房颤的相关文献,时间截止为2021年6月,检索关键词为:"Nonvalvular atrial fibrillation"、"Left atrial ...     

老年心房颤动患者抗凝防治现状及口服抗凝药疗效和安全性单中心分析

目的 分析单中心老年心房颤动(房颤)患者的抗凝防治现状,并评价口服抗凝药的疗效和安全性.方法 连续收集2018年1月～2020年12月解放军总医院住院的老年房颤患者4239例,详细记录患者病历资料,总结不同抗凝方案的应用现状,最终纳入随访患者1647例,中位随访时间23.5个月,最长随访时间36.4个月.根据在院抗凝方...     

老年心房颤动患者的华法林抗凝治疗

脑卒中是严重威胁我国老年人群健康的主要疾病之一,规范的抗凝治疗可以显著减少与心房颤动(房颤)相关的心源性脑卒中的发生率。现对老年房颤患者的华法林抗凝治疗的有关问题作一阐述。1老年房颤的流行病学房颤是最常见的心律失常。在美国,约有230万房颤患者,每年因房颤住院的患     

心房颤动患者应用新型口服抗凝药的出血风险及出血管理

<正>心房颤动(atrial fibrillation,AF)是一种室上性快速性心律失常,心房颤动患者由于心房有效收缩功能降低,血流动力学紊乱,血流瘀滞,易形成血栓,导致脑卒中的发生风险明显增加^[1]。脑卒中是心房颤动的严重并发症,与非心房颤动相关卒中相比,心房颤动相关卒中死亡率和致残率更高,多预后不佳。而合理应用口服抗凝药可以有效降低心房颤动患者的脑卒中风险^[2],     

心房颤动抗凝药物的最新研究进展

大部分心房颤动（AF）患者都需要接受抗凝治疗,2014年美国心脏学会更新的AF抗凝指南将新型口服靶向抗凝药划入选择的范畴。本文就AF抗凝药物的最新研究进展作一介绍。     

心房颤动合并肿瘤患者应用新型口服抗凝剂的有效性及安全性的Meta分析

目的:评估新型口服抗凝剂(NOAC)相比华法林应用于心房颤动合并肿瘤患者中的有效性及安全性.方法:计算机检索Pubmed、EMBASE、Cochrane等数据库,并追踪以获文献的参考文献,检索时间范围为各数据库建库至2020年1月.按照纳入及排除标准筛选文献,并进行质量评价.应用Revman5.3软件对数据进行Meta...     

90岁及以上老年心房颤动患者口服抗凝药的安全性和有效性分析

目的评估90岁及以上老年心房颤动患者口服抗凝药的临床疗效和安全性。方法回顾性分析2014年1月至2017年12月于苏州大学附属第一医院心内科及神经内科病房或门诊记录的行抗凝治疗的125例90岁及以上非瓣膜性心房颤动患者,抗凝药物包含维生素K拮抗剂华法林、非维生素K拮抗剂口服抗凝药(NOAC)达比加群和利伐沙班。平均随访(14.0±5.2)个月,主要终点事件包括脑梗死、短暂性脑缺血发作(TIA)、系统性栓塞和大出血;次要终点事件包括全因死亡和停药。结果 125例患者中,华法林组54例,NOAC组71例,主要终点事件:缺血性事件7例,大出血事件14例;次要终点事件:停药36例,全因死亡19例。经R软件进行竞争风险生存分析显示,既往缺血性事件(脑卒中或TIA,SHR=3.47,95%CI:1.94～7.51,P=0.008)、血管性疾病(SHR=2.89,95%CI:1.27～6.60,P=0.012)、CHA_2DS_2-VASc≥2分(SHR=3.54,95%CI:0.46～7.60,P=0.048)是本研究中发生缺血性事件的独立预测因子,既往出血性事件(SHR=4.53,95%CI:1.37～4.64,P=0.002)、HAS-BLED≥3分(SHR=5.65,95%CI:0.76～6.71,P=0.005)是本研究中大出血的独立预测因子。结论 90岁及以上老年心房颤动患者行抗凝治疗是安全且有效的,既往发生过缺血性事件、有血管性疾病病史、CHA_2DS_2-VASc≥2分的患者更容易发生缺血性事件,有出血病史、HAS-BLED≥3分的患者更容易发生出血性事件。     

非瓣膜性心房颤动应用新型口服抗凝药依从性分析

目的探讨非瓣膜性心房颤动(房颤)患者应用新型口服抗凝药(new oral anticoagulants,NOACs)的依从性及其主要影响因素。方法连续入选2018年1月1日至2018年12月31日于徐州医科大学附属医院心内科住院并行保守抗凝治疗的非瓣膜性房颤性患者272例,根据应用抗凝药种类不同分为华法林组96例和新型口服抗凝药组176例,出院后进行电话随访,比较两组患者抗凝依从性和各自停药原因及影响因素。结果华法林组与NOACs组患者在性别分布、心功能分级、合并疾病方面无统计学差异。平均随访(8.80±3.51)月,NOACs组停药率显著高于华法林组(57.39%vs.22.92%,P<0.001)。对房颤疾病本身及其危害认识不足是两组患者停药的共同主要原因,经济因素、购买因素、出血因素、对疾病缺乏认识对两组患者停用抗凝药均具有显著影响。结论目前新型口服抗凝药服药依从性仍较低,多种因素影响房颤抗凝,其中对房颤缺乏正确认识是导致患者停药的主要原因。     

新型口服抗凝药在治疗血栓栓塞性疾病中的研究进展

血栓栓塞性疾病是由血栓形成和血栓栓塞两种病理过程所引起的疾病,严重威胁人类健康。抗凝药物被广泛应用于血栓栓塞性疾病的预防和治疗,传统的抗凝药包括肝素、低分子肝素、华法林,在预防和治疗血栓栓塞性疾病的有效性已被众多临床研究证实。近年来,各类新型口服抗凝药物不断涌现,如达比加群、利伐沙班、阿哌沙班和依度沙班。现对新型口服抗凝药物的分类及临床应用的研究进展做一综述。     

Relationship between the nutritional status and safety and efficacy outcomes in atrial fibrillation patients aged 80 years and over receiving oral anticoagulants

BackgroundMalnutrition has been reported to be associated with worse clinical outcomes in various cardiovascular diseases. We aimed to investigate the clinical significance of the nutritional status in atrial fibrillation (AF) patients aged 80 years and over receiving oral anticoagulants (OACs), focusing on the difference between direct OACs (DOACs) and warfarin treatment.MethodsThis was a retrospective and observational study. We enrolled 332 consecutive AF patients aged 80 years and over who were treated with OACs: DOACs (n = 256) and warfarin (n = 76). A controlling nutritional status (CONUT) score was used to evaluate the nutritional status. The enrolled patients were divided into two groups based on the CONUT score: CONUT score <5 (n = 239) and CONUT score ≥5 (n = 93) groups. We investigated the relationship between the nutritional status and clinical outcomes.ResultsThe CONUT score ≥5 group had significantly higher incidence of major bleeding (MB) compared to the CONUT score <5 group (4.6/100 person-years vs. 0.7/100 person-years, p < 0.01). On Cox hazard analysis, CONUT score ≥5 group was significantly associated with increased MB compared with the CONUT score <5 group (hazard ratio: 5.80, 95% confidence interval: 1.44–23.33, p = 0.013). In the DOAC group, the incidence of MB did not differ between the CONUT score ≥5 and CONUT score <5 groups (p = 0.54). In the warfarin group, MB occurred more frequently in the CONUT score ≥5 group than CONUT score <5 group (p < 0.01). There was no significant difference in the incidence of thromboembolic events between the CONUT score ≥5 and CONUT score <5 groups in both the DOAC and warfarin groups.ConclusionsThe prognostic values of the nutritional status based on the CONUT score for MB differed between AF patients aged 80 years and over receiving DOACs and those receiving warfarin. It may be favorable to use DOACs to avoid bleeding events in those with malnutrition.     

Underuse of oral anticoagulants in patients with nonvalvular atrial fibrillation in Italy

Abstract Introduction: Oral anticoagulants (OAs) are significantly more effective than Aspirin in the prevention of cerebrovascular accidents among patients with atrial fibrillation (AF). Several studies, however, showed OAs to be widely underused in these patients. Objective: To assess the appropriateness of antithrombotic therapy in an Italian population of AF patients. Methods: Two hundred and fifty-five consecutive patients affected by nonvalvular AF participated in the study. Data were collected on demographic characteristics, risk factors for stroke, current prophylactic therapy, and perceived or actual risk factors for bleeding. INR levels were measured. Patients were stratified by their risk for stroke (214 at high risk, 21 moderate, 20 low), and their prophylactic therapy was analysed in light of international antithrombotic therapy recommendations. After therapy adjustment, 203 of our patients were followed-up for the occurrence of cerebrovascular events for an average of 27 months. Results: Upon admission, 35% (n=75) of patients in the high-risk category were either taking no antithrombotic prophylaxis or were being treated with Aspirin. In addition, 38 of 139 patients receiving OAs had an INR<2. Thus, a total of 113 (52.8%) high-risk subjects were not receiving adequate antithrombotic therapy. Of high-risk patients not treated with OAs, 46.7% reported no perceived or actual risk factors for bleeding. The annual incidence of cerebrovascular accidents was 3.8% among 163 high-risk patients assigned to OA treatment, and 4.5% among 39 patients given Aspirin treatment. Relative to expected annual incidence rates, cerebrovascular risk in anticoagulated patients was reduced by about 70%. Conclusions: Underuse of OAs is still common in Italy, and much of it cannot be explained by the concern for haemorrhage. Support and training in the complex task of anticoagulation management may help to extend this efficacious prophylactic therapy to all patients who may benefit from it.     

Real-world oral anticoagulants for Asian patients with non-valvular atrial fibrillation: A PRISMA-compliant article

Background and Purpose:This study aimed to evaluate the comparative efficacy and safety of 4 non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in Asians with non-valvular atrial fibrillation in real-world practice through a network meta-analysis of observational studies.Methods:We searched multiple comprehensive databases (PubMed, Embase, and Cochrane library) for studies published until August 2020. Hazard ratios and 95% confidence intervals were used for the pooled estimates. Efficacy outcomes included ischemic stroke (IS), stroke/systemic embolism (SSE), myocardial infarction (MI), and all-cause mortality, and safety outcomes included major bleeding, gastrointestinal (GI) bleeding, and intracerebral hemorrhage (ICH). The P score was calculated for ranking probabilities. Subgroup analyses were separately performed in accordance with the dosage range of NOACs (“standard-” and “low-dose”).Results:A total of 11, 6, and 8 studies were allocated to the total population, standard-dose group, and low-dose group, respectively. In the total study population, edoxaban ranked the best in terms of IS and ICH prevention and apixaban ranked the best for SSE, major bleeding, and GI bleeding. In the standard-dose regimen, apixaban ranked the best in terms of IS and SSE prevention. For major bleeding, GI bleeding, and ICH, edoxaban ranked the best. In the low-dose regimen, edoxaban ranked the best for IS, SSE, GI bleeding, and ICH prevention. For major bleeding prevention, apixaban ranked best.Conclusions:All 4 NOACs had different efficacy and safety outcomes according to their type and dosage. Apixaban and edoxaban might be relatively better and more well-balanced treatment for Asian patients with non-valvular atrial fibrillation.