An updated review of target-specific oral anticoagulants used in stroke prevention in atrial fibrillation, venous thromboembolic disease, and acute coronary syndromes.
An updated review of target-specific oral anticoagulants used in stroke prevention in atrial fibrillation, venous thromboembolic disease, and acute coronary syndromes.
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DOI：
10.1161/jaha.113.000136
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发表时间：
2013-10-23
影响因子：
5.4
通讯作者：
Hylek EM
中科院分区：
文献类型：
--
作者：
Cove CL;Hylek EM
心房颤动（AF）是成人人群中常见的心律失常。与非AF相关卒中相比，其卒中风险增加5倍，导致发病率和死亡率更高。1目前成人人群中AF的患病率估计为1%-2%，预计到2050年将增加5倍，这反过来将增加老龄人群中缺血性卒中的总体负担。2，3已经开发了各种卒中风险分层方案来量化AF患者的卒中风险，并指导临床医生做出预防性治疗决策。最广泛使用的是CHADS 2评分，该评分根据充血性心力衰竭、高血压、年龄75岁或以上、糖尿病和既往卒中或短暂性脑缺血发作（TIA）的存在来估计风险。4CHADS 2方案的修订版已开发用于AF卒中风险评估。它将年龄二分，并纳入血管疾病和女性性别，以创建CHA 2DS 2-VASc（VA，血管疾病; Sc，性别类别）评分5（表1）。与CHADS 2相比，该卒中风险分层方案能够更好地区分处于最低风险的个体。6-8例如，在CHADS 2评分为0的患者中，1年卒中和栓塞事件发生率范围为0.84%（CHA 2DS 2-VASc评分为0）至3.2%（CHA 2DS 2-VASc评分为3）。8根据两种风险分层方案，除非存在主要禁忌症，否则建议评分≥ 1的患者接受口服抗凝治疗。只有那些年龄< 65岁，
Atrial fibrillation (AF) is a common arrhythmia in the adult population. It is associated with up to a 5-fold increased risk of stroke and contributes to a higher morbidity and mortality compared with non–AF-related strokes. 1 The current prevalence of AF in the adult population, estimated at 1% to 2%, is expected to increase by up to 5 times by 2050, which will in turn increase the overall burden of ischemic stroke in the aging population. 2, 3 Various stroke risk stratification schemes have been developed to quantify stroke risk in patients with AF and guide preventive treatment decisions for the clinician. The most widely used has been the CHADS2 score, which estimates risk based on the presence of congestive heart failure, hypertension, age 75 years or greater, diabetes mellitus, and prior stroke or transient ischemic attack (TIA). 4A revision of the CHADS2 scheme has been developed for use in stroke risk assessment in AF. It dichotomizes age and incorporates vascular disease and female sex, to create the CHA2DS2-VASc (VA, vascular disease; Sc, sex category) score5 (Table 1). Compared with CHADS2, this stroke risk stratification scheme is better able to discriminate among individuals at lowest risk. 6–8 For example, in patients with a CHADS2 score of 0, the 1-year stroke and embolic event rates range from 0.84%(CHA2DS2-VASc score of 0) to 3.2%(CHA2DS2-VASc score of 3). 8 By both risk stratification schemes, those patients who score≥ 1 are recommended to receive oral anticoagulant therapy unless major contraindications are present. Only those who are< 65 years of age and