EPIDEMIOLOGY OF ANTICOAGULATION IN ATRIAL FIBRILLATION

描述：(改编自《调查者摘要》)房颤 (房颤)影响4%的60岁以上的人，也是最潜在的风险 中风的因素(相对风险为5)；占所有中风的15%，包括 那些年龄&80岁的人可归因于房颤。七个随机试验(RCT)有 研究表明，抗凝可以安全地消除由于以下原因而导致的几乎所有中风风险 自动对焦。尽管如此，只有三分之一的房颤患者接受了 抗凝血剂，其中只有19%的年龄段&80岁。医生们 关注华法林的安全性，特别是在 老年人，以及监测抗凝的负担。令人担忧的问题 关于出血风险的一些观察性研究支持 临床实践，并通过一次随机对照试验(SPAF II)。因此，最近的几个 指南建议老年人使用阿司匹林，尽管有证据表明 其治疗房颤的疗效较弱。 当前的应用程序旨在提供丰富的信息源 关于房颤抗凝在“真实世界”实践中的最佳翻译 在RCT中看到的疗效转化为常规临床护理。它还将 为评估房颤患者卒中风险的遗传标记提供资源。 调查人员将召集两大队列：1.8000名门诊患者 CA北部Kaiser Permanente合并房颤2.2500例患者 由弥撒管理。综合医院抗凝治疗单元。 这些群体的后续行动将涉及两个重要的、相互关联的主题，如 如下：1.在临床实践中明确卒中和中风的发生率 房颤患者同时使用和不使用抗凝药物时的出血； 确定优化抗凝控制的策略。具体来说， 研究内容如下：1.精确度高、通用性强 华法林对房颤患者大出血发生率的评估 临床护理；2.特别是大出血的临床危险因素 评估老年人；3.血栓栓塞率的准确估计 (TE)未服用抗凝剂的房颤患者；4.临床危险因素 血栓栓塞症合并房颤；5.血栓形成风险的新标记物的评估 因子V Leiden基因突变；6.最佳强度的估计 房颤的抗凝治疗；7.控制不良的决定因素的鉴定 抗凝剂的使用；8.确定使用 房颤的抗凝；9.抗凝质量的比较 由抗凝单位提供的与初级医生提供的相比。这个 调查人员表示，这项研究应该会带来重要的健康和 给美国老年人带来的经济利益。

DESCRIPTION: (Adapted from Investigator's Abstract) Atrial fibrillation (AF) affects 4% of people over age 60, and it is also the most potent risk factor for stroke (relative risk of 5); 15% of all stroke, including >30% in those age >80, is attributable to AF. Seven randomized trials (RCTs) have shown anticoagulation can safely remove nearly all the risk of stroke due to AF. Nonetheless, only 1/3 of patients with AF are treated with anticoagulants, including only 19% of those age >80. Physicians are concerned about warfarin's safety in usual practice, particularly among the elderly, and about the burdens of monitoring anticoagulation. Concerns about risk of hemorrhage are supported by some observational studies of clinical practice, and by one RCT (SPAF II). As a result, several recent guidelines have suggested aspirin be used in the elderly, although evidence for its efficacy in AF is weak. The current application is designed to provide a rich source of information about anticoagulation for AF in 'real world' practice to optimally translate the efficacy seen in the RCTs into usual clinical care. It will also provide a resource for assessing genetic markers of risk of stroke in AF. The investigators will assemble two large cohorts: 1. the 8000 outpatients with AF in Kaiser Permanente of Northern CA; and 2. the 2500 patients managed by the Mass. General Hospital Anticoagulant Therapy Unit. Follow-up of these cohorts will address two important, linked topics, as follow: 1. specifying in clinical practice the rates of stroke and hemorrhage among patients with AF both on and off anticoagulants; and 2. identifying strategies to optimize control of anticoagulation. In detail, the research will provide the following: 1. precise and generalizable estimates of the rates of major bleeding of AF patients on warfarin in clinical care; 2. clinical risk factors for major bleeding, in particular assessing older age; 3. precise estimates of the rates of thromboembolism (TE) among AF patients not on anticoagulants; 4. clinical risk factors for TE with AF; 5. assessment of a novel marker of thrombosis risk -- the factor V Leiden gene mutation; 6. estimates of the optimal intensity of anticoagulation for AF; 7. identification of determinants of poor control of anticoagulation; 8. identification of correlates of the use of anticoagulation in AF; and 9. comparison of the quality of anticoagulation provided by anticoagulation units versus that of primary physicians. The investigators state that this research should lead to important health and economic benefits for older Americans.