The Effect of Bleeding Risk and Frailty Status on Anticoagulation Patterns in Octogenarians With Atrial Fibrillation: The FRAIL-AF Study
The Effect of Bleeding Risk and Frailty Status on Anticoagulation Patterns in Octogenarians With Atrial Fibrillation: The FRAIL-AF Study
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DOI：
10.1016/j.cjca.2015.05.012
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发表时间：
2016-02-01
影响因子：
6.2
通讯作者：
Tannenbaum, Cara
中科院分区：
文献类型：
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作者：
Lefebvre, Marie-Claude D.;St-Onge, Maude;Tannenbaum, Cara
背景：老年人房颤（AF）、血栓栓塞并发症和出血的风险增加。相当大比例的老年人没有接受抗凝治疗。本研究的目的是探讨血栓栓塞的风险，出血的风险，和脆弱的抗凝状态的老年人住院AF。方法：一项横断面研究进行了682例住院患者年龄80岁及以上的AF或房扑在蒙特利尔，魁北克。记录华法林或新的口服抗凝剂的使用情况。使用临床虚弱量表（CFS）确定每位患者的虚弱状态，并评估卒中（CHADS（2）[充血性心力衰竭、高血压、年龄、糖尿病、卒中/短暂性脑缺血发作]）和出血的风险（HAS-BLED [高血压、肾/肝功能异常、卒中、出血史或易感性、不稳定的国际标准化比值，老年人（> 65岁）药物/酒精伴随]）。单变量和多变量Logistic回归分析被用来检查脆弱的状态和中风和出血的风险接受抗凝治疗的概率的影响。结果：70%的老年人与AF接受抗凝治疗（n = 475）。在多变量分析中，高卒中风险（CHADS 2 = 3与CHADS 2 = 1，比值比[OR]，3.58; 95%置信区间[CI]，1.09-11.77）和无严重虚弱（CFS < 7; OR，3.41; 95% CI，1.84-6.33）与抗凝剂使用独立相关。出血的高风险（HAS-BLED评分>= 3; OR，0.33; 95%CI，0.12-0.86）与抗凝治疗的缺乏相关。结论：我们的研究表明，与以前的研究相比，老年房颤患者中适当抗凝治疗的患病率较高。需要进一步的工作来开发和传播工具，以优化抗凝剂在这一高危人群中的使用。
Background: Older adults are at increased risk of atrial fibrillation (AF), its thromboembolic complications, and bleeding. A significant percentage of octogenarians do not receive anticoagulation therapy. The objective of this study was to investigate the effect of thromboembolic risk, bleeding risk, and frailty on the anticoagulation status of octogenarians hospitalized with AF.Methods: A cross-sectional study was conducted in 682 hospitalized patients aged 80 years and older with AF or atrial flutter in Montreal, Quebec. Consumption of warfarin or a new oral anticoagulant was documented. Medical record data were used to determine each patient's frailty status using the Clinical Frailty Scale (CFS) and to evaluate the risk of stroke (CHADS(2) [Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack]) and bleeding (HAS-BLED [Hypertension, Abnormal renal/liver function,Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years) Drugs/alcohol concomitantly]). Univariable and multivariable logistic regression analyses were used to examine the effect of frailty status and the risk of stroke and bleeding on the probability of receiving anticoagulation therapy.Results: Seventy percent of octogenarians with AF received anticoagulation therapy (n = 475). A high risk of stroke (CHADS2 = 3 compared with CHADS2 = 1, odds ratio [OR], 3.58; 95% confidence interval [CI], 1.09-11.77), and the absence of severe frailty (CFS < 7; OR, 3.41; 95% CI, 1.84-6.33) were independently associated with anticoagulant use in multivariable analyses. A high risk of bleeding (HAS-BLED score >= 3; OR, 0.33; 95% CI, 0.12-0.86) was associated with the absence of anticoagulation.Conclusions: Our study suggests a higher prevalence of appropriate anticoagulation among octogenarians with AF than reported in previous studies. Further work is needed to develop and disseminate tools to optimize the use of anticoagulants in this high-risk population.