Selecting patients with atrial fibrillation for anticoagulation - Stroke risk stratification in patients taking aspirin
Selecting patients with atrial fibrillation for anticoagulation - Stroke risk stratification in patients taking aspirin
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DOI：
10.1161/01.cir.0000145172.55640.93
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发表时间：
2004-10-19
期刊：
影响因子：
37.8
通讯作者：
Petersen, P
中科院分区：
文献类型：
--
作者：
Gage, BF;van Walraven, C;Petersen, P
背景-心房颤动(房颤)的卒中发生率取决于是否存在并存的情况和抗血栓治疗的使用。虽然调整剂量的华法林在减少房颤患者的卒中方面优于阿司匹林，但华法林的绝对风险降低取决于阿司匹林的卒中发生率。这项前瞻性队列研究测试了5种中风风险分层方案的预测准确性。方法和结果-该研究汇集了2580名非瓣膜性房颤参与者的个人数据，这些参与者在一项多中心试验中服用了阿司匹林(AFASAK-1，AFASAK-2，欧洲房颤试验，一级预防非风湿性房颤患者的动脉血栓栓塞症，以及卒中预防和房颤[SPAF]-III高风险或SPAF-III低风险)。在4887名患者接受阿司匹林治疗期间，共有207例缺血性中风。所有方案对中风的预测都比机率更好，但被归类为低风险和高风险的患者数量差别很大。所有5种方案均将既往有脑缺血病史的房颤患者列为高危患者，每100人年发生10.8次中风。CHADS(2)方案(充血性心力衰竭、高血压、年龄和75岁、糖尿病和既往中风或短暂性脑缺血发作的首字母缩写)成功地确定了中风的高风险一级预防患者(每100个病人年有5.3个中风)。相比之下，被其他方案确定为高风险的患者每100个人年有3.0到4.2个中风。所有方案确定的低风险患者每100人年有0.5至1.4次中风。结论-服用阿司匹林时中风发生率高和低的房颤患者可以可靠地确定，允许个体化选择抗血栓预防药物。
Background - The rate of stroke in atrial fibrillation (AF) depends on the presence of comorbid conditions and the use of antithrombotic therapy. Although adjusted-dose warfarin is superior to aspirin for reducing stroke in AF, the absolute risk reduction of warfarin depends on the stroke rate with aspirin. This prospective cohort study tested the predictive accuracy of 5 stroke risk stratification schemes.Methods and Results - The study pooled individual data from 2580 participants with nonvalvular AF who were prescribed aspirin in a multicenter trial ( Atrial Fibrillation, Aspirin, Anticoagulation I study [AFASAK-1], AFASAK-2, European Atrial Fibrillation Trial, Primary Prevention of Arterial Thromboembolism in patients with nonrheumatic Atrial Fibrillation in primary care study, and Stroke Prevention and Atrial Fibrillation [SPAF]-III high risk or SPAF-III low risk). There were 207 ischemic strokes during 4887 patient-years of aspirin therapy. All schemes predicted stroke better than chance, but the number of patients categorized as low and high risk varied substantially. AF patients with prior cerebral ischemia were classified as high risk by all 5 schemes and had 10.8 strokes per 100 patient-years. The CHADS(2) scheme ( an acronym for Congestive heart failure, Hypertension, Age > 75, Diabetes mellitus, and prior Stroke or transient ischemic attack) successfully identified primary prevention patients who were at high risk of stroke (5.3 strokes per 100 patient- years). In contrast, patients identified as high risk by other schemes had 3.0 to 4.2 strokes per 100 patient- years. Low-risk patients identified by all schemes had 0.5 to 1.4 strokes per 100 patient- years of therapy.Conclusions - Patients with AF who have high and low rates of stroke when given aspirin can be reliably identified, allowing selection of antithrombotic prophylaxis to be individualized.