Use of the CHA2DS2-VASc and HAS-BLED Scores to Aid Decision Making for Thromboprophylaxis in Nonvalvular Atrial Fibrillation
Use of the CHA2DS2-VASc and HAS-BLED Scores to Aid Decision Making for Thromboprophylaxis in Nonvalvular Atrial Fibrillation
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DOI：
10.1161/circulationaha.111.060061
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发表时间：
2012-08-14
期刊：
影响因子：
37.8
通讯作者：
Lip, Gregory Y. H.
中科院分区：
文献类型：
--
作者：
Lane, Deirdre A.;Lip, Gregory Y. H.
在房颤患者抗血栓治疗方面的860个变化。首先，新的数据出现了以前被认为是不太有效的卒中危险因素，即女性、65至74岁和血管疾病。7,8其次，队列研究已经证明OAC在卒中减少和死亡率方面优于阿司匹林，即使在所谓的中等风险患者中（例如，CHADS2评分为1）。1第三，阿司匹林对房颤卒中预防的益处一直受到质疑。最后，3个大型随机对照试验表明，与华法林相比，新型OAC药物在疗效和安全性方面都不差，在某些情况下，甚至更优。鉴于房颤的卒中风险是连续的，基于风险因素的风险评估方法导致了一种模式的转变，现在的重点是更好地识别真正的低风险患者，他们不需要任何抗血栓治疗，而那些只有一个卒中风险因素的患者可以考虑进行有效的卒中预防治疗，这本质上是OAC，无论是使用控制良好的剂量调整华法林还是一种新药。
860 changes in the antithrombotic management of patients with AF. First, new data have emerged on what were previously referred to as less well validated risk factors for stroke, namely female sex, age of 65 to 74 years, and vascular disease. 7, 8 Second, cohort studies have demonstrated the benefit of OAC over aspirin in terms of stroke reduction and mortality, even in patients at so-called moderate risk (eg, CHADS2 score of 1). 1 Third, the benefit of aspirin for stroke prophylaxis in AF has been questioned. 9 Finally, 3 large randomized, controlled trials of novel OAC drugs have demonstrated noninferiority—in some cases, superiority—compared with warfarin in terms of both efficacy and safety. Given that stroke risk in AF is a continuum, a risk factor–based approach to risk assessment has resulted in a paradigm shift that now focuses on better identification of truly low-risk patients who do not need any antithrombotic therapy, whereas those with 1 stroke risk factors can be considered for effective stroke prevention therapy, which is essentially OAC, whether with well-controlled dose-adjusted warfarin or one of the new agents.