Anticoagulant use for atrial fibrillation in the elderly
Anticoagulant use for atrial fibrillation in the elderly
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DOI：
10.1111/j.1532-5415.2004.52314.x
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发表时间：
2004-07-01
影响因子：
6.3
通讯作者：
Fiore, LD
中科院分区：
文献类型：
--
作者：
Brophy, MT;Snyder, KE;Fiore, LD
目的：确定高龄对房颤患者使用抗凝剂的影响，并探讨卒中危险因素和抗凝治疗禁忌症对随后使用抗凝剂的预测程度。设计：回顾性队列研究。地点：退伍军人事务部波士顿医疗保健系统。参与者：共2,217例非瓣膜性房颤患者。测量：管理数据库用于确定受试者的年龄、抗凝剂使用情况以及房颤、脑血管意外、高血压、糖尿病、充血性心力衰竭或胃肠道或脑出血的诊断。未经调整的分析显示，无论是否存在，75岁的受试者与年龄较大和较年轻的受试者之间的华法林使用没有差异。（33.9% vs 35.7%，P=.37）或无（33.4% vs 34.7%，P=.58）抗凝治疗禁忌症。多变量建模显示，随着生命的每十年增长，抗凝剂使用减少14%（95%置信区间（CI）=4-22%）。颅内出血是一个显着的威慑（比值比（OR）=0.27 95% CI=0.06-0.85）。高血压病史（OR=2.90，95%CI =2.15-3.89），充血性心力衰竭（OR=1.70，95%CI =1.41-2.04），脑血管意外（OR=1.54，95%CI =1.25-1.89）是抗凝剂使用的独立预测因素。尽管有共识的指南，以治疗所有75岁及以上的房颤患者与抗凝剂，年龄增长被发现是一个威慑华法林的使用。需要更好地估计老年房颤患者口服抗凝剂治疗的风险：获益比，以优化决策。
OBJECTIVES: To determine the influence of advanced age on anticoagulant use in subjects with atrial fibrillation and to explore the extent to which risk factors for stroke and contraindications to anticoagulant therapy predict subsequent use.DESIGN: Retrospective cohort study.SETTING: The Veterans Affairs Boston Healthcare System.PARTICIPANTS: A total of 2,217 subjects with nonvalvular atrial fibrillation.MEASUREMENTS: Administrative databases were use to identify subject's age, anticoagulant use, and the presence of a diagnosis of atrial fibrillation, cerebrovascular accident, hypertension, diabetes mellitus, congestive heart failure, or gastrointestinal or cerebral hemorrhage.RESULTS: Unadjusted analysis showed no difference in warfarin use between those aged 75 and older and younger subjects regardless of the presence (33.9% vs 35.7%, P=.37) or absence (33.4% vs 34.7%, P=.58) of contraindications to anticoagulant therapy. Multivariate modeling demonstrated a 14% reduction (95% confidence interval (CI)=4-22%) in anticoagulant use with each advancing decade of life. Intracranial hemorrhage was a significant deterrent (odds ratio (OR)=0.27 95% CI=0.06-0.85). History of hypertension (OR=2.90, 95% CI=2.15-3.89), congestive heart failure (OR=1.70, 95% CI=1.41-2.04), and cerebrovascular accident (OR=1.54, 95% CI=1.25-1.89) were significant independent predictors for anticoagulant use.CONCLUSION: Despite consensus guidelines to treat all atrial fibrillation patients aged 75 and older with anticoagulants, advancing age was found to be a deterrent to warfarin use. Better estimates of the risk:benefit ratio for oral anticoagulant therapy in older patients with atrial fibrillation are needed to optimize decision-making.