Risk factors for thromboembolism during aspirin therapy in patients with atrial fibrillation: The stroke prevention in atrial fibrillation study.
Risk factors for thromboembolism during aspirin therapy in patients with atrial fibrillation: The stroke prevention in atrial fibrillation study.
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DOI：
10.1016/s1052-3057(10)80166-1
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发表时间：
1995-01-01
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虽然心房颤动（AF）与缺血性脑卒中有关，但一些房颤患者的血栓栓塞率本身就很低。其他房颤患者服用阿司匹林后血栓栓塞率可能较低。我们进行了探索性分析，以确定阿司匹林治疗期间与血栓栓塞相关的患者特征，作为临床试验设计的基础。在一项临床试验中，对854名服用阿司匹林325毫克/天并平均随访2.3年的患者进行了分析。通过多变量分析，研究开始时的临床和超声心动图特征与随后的动脉血栓栓塞相关。服用阿司匹林的房颤患者血栓栓塞率高的是75岁以上的女性（10.4%/年）和收缩压为bb0 160t（7.6%/年）、既往血栓栓塞（6.4%/年）和左心室功能受损（5.5%/年）的任何性别患者。具有上述一项或多项特征的房颤患者在阿司匹林治疗期间血栓栓塞率为5.9%/年（95% CI 4.5-7.8）。没有这些特征的患者占队列的52%，血栓栓塞率为每年1.9% （95% CI, 1.2-2.9）。所有亚组中的大多数卒中均被归类为心源性卒中；心源性卒中发生率最高的是老年女性（6.1%/年）。这些探索性分析表明，许多房颤患者在服用阿司匹林后血栓栓塞率可能相对较低，但这些发现必须在应用于临床管理之前得到独立证实。高危特征和阿司匹林反应性的致病介质尚不清楚。
Although atrial fibrillation (AF) is associated with ischemic stroke, some AF patients have an inherently low rate of thromboembolism. Additional AF patients might have a low thromboembolic rate when given aspirin. We undertook exploratory analyses to identify patient features related to thromboembolism during aspirin therapy, as the basis for the design of a clinical trial. A cohort of 854 patients given aspirin 325 mg/day and followed for a mean of 2.3 years in a clinical trial was analyzed. Clinical and echocardiographic features at study entry were correlated with subsequent arterial thromboembolism by multivariate analysis. AF patients given aspirin who had high thromboembolic rates were women over age 75 years (10.4%/year) and those of either gender with systolic blood pressure > 160 T (7.6%/year), prior thromboembolism (6.4%/year), and impaired left ventricular function (5.5%/year). AF patients with one or more of these features had a thromboembolic rate of 5.9%/year (95% CI 4.5-7.8) during aspirin therapy. Patients without these features comprised 52% of the cohort and had a thromboembolic rate of 1.9% per year (95% CI, 1.2-2.9). Most strokes in all subgroups were classified as cardioembolic; the highest rate of cardioembolic stroke occurred in elderly women (6.1%/year). These exploratory analyses suggest that many AF patients may have a relatively low thromboembolic rate when given aspirin, but the findings must be independently confirmed before being applied to clinical management. Pathogenic mediators of high-risk features and aspirin responsiveness are unclear.