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首页> 外文期刊>Cardiovascular therapeutics >Contraindications to Anticoagulation Therapy and Eligibility for Novel Anticoagulants in Older Patients with Atrial Fibrillation
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Contraindications to Anticoagulation Therapy and Eligibility for Novel Anticoagulants in Older Patients with Atrial Fibrillation

机译：老年房颤患者抗凝治疗的禁忌症和新型抗凝药的资格

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Aims: Oral anticoagulation therapy prevents stroke and improves survival in patients with atrial fibrillation, but the therapy is underutilized. We sought to identify the prevalence of contraindications for oral anticoagulation and the proportion of patients potentially eligible for different agents. Methods: We identified patients with nonacute atrial fibrillation in a nationally representative 5% sample of 2009 Medicare data. We divided the population into patients ineligible for any oral anticoagulant, patients eligible for warfarin only, and patients eligible for any anticoagulant. We compared patient characteristics and the use of anticoagulation among the subgroups. Results: Among 86,671 patients with atrial fibrillation, 1872 (2.2%) were ineligible for anticoagulation because of an absolute contraindication, most frequently a history of intracranial hemorrhage (60%). Patients ineligible for any anticoagulant were the same age as the overall group (mean age, 80.5 vs. 80.4 years). However, they had higher rates of dementia (19% vs. 8.6%) and heart failure (59% vs. 43%) and higher mean CHADS(2) scores (3.8 vs. 2.8). Of the remaining 84,799 patients eligible for anticoagulation, 7146 (8.4%) were eligible for warfarin only (most commonly because of mechanical heart valves [66%] and end-stage renal disease [12%]). Sixty-five percent of patients eligible for anticoagulation received warfarin, and the proportion was similar for patients with a relatively high risk of bleeding. Conclusions: Older adults with atrial fibrillation rarely have absolute contraindications to oral anticoagulation therapy. Among patients without contraindications, most appeared to be eligible for any anticoagulant, and relatively high-risk features appeared not to influence warfarin use.
机译：目的：口服抗凝疗法可预防中风并改善房颤患者的生存率，但该疗法未得到充分利用。我们试图确定口服抗凝禁忌症的患病率以及可能有资格使用不同药物的患者比例。方法：我们在全国代表性的2009年Medicare数据的5％样本中确定了非急性房颤患者。我们将人群分为不适合使用任何口服抗凝剂的患者，仅适合使用华法林的患者和符合任何抗凝剂的患者。我们比较了亚组之间的患者特征和抗凝药的使用。结果：在86,671名房颤患者中，有1872名（2.2％）由于绝对禁忌症而没有抗凝治疗的资格，最常见的是颅内出血史（60％）。不适合使用任何抗凝剂的患者的年龄与总体年龄相同（平均年龄为80.5岁vs. 80.4岁）。但是，他们的痴呆发生率较高（分别为19％和8.6％）和心力衰竭（分别为59％和43％）和CHADS（2）平均得分较高（3.8和2.8）。在其余的84799例接受抗凝治疗的患者中，只有7146例（占8.4％）有资格使用华法林（最常见的原因是由于机械性心脏瓣膜[66％]和终末期肾脏疾病[12％]）。有资格接受抗凝治疗的患者中有65％接受了华法林，而出血风险相对较高的患者所占的比例相似。结论：老年房颤的患者很少对口服抗凝治疗有绝对禁忌症。在没有禁忌症的患者中，大多数似乎有资格使用任何抗凝剂，并且相对较高的风险特征似乎不影响华法林的使用。

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