Baidu
map

JAHA:多少房颤患者在大出血后不再抗凝?

2018-08-09 吴星 环球医学

2018年6月,美国学者在《J Am Heart Assoc》发表了ORBIT-AF结果,考察了房颤患者中,大出血、临床相关非大出血和滋扰性出血后的治疗策略。

2018年6月,美国学者在《J Am Heart Assoc》发表了ORBIT-AF结果,考察了房颤患者中,大出血、临床相关非大出血和滋扰性出血后的治疗策略。

背景:口服抗凝药(OAC)可降低房颤患者卒中风险,但是出血是常见的副作用。因出血事件而决定停止或修改用药方案,根据出血部位和严重程度的不同而具有差异。

方法和结果:研究者使用一个大型全国门诊患者注册ORBIT-AF(房颤更明智治疗的结局;2010~2011)的数据,评估事件特征和随访期首次出血事件后的OAC管理。出血事件分为3类:(1)国际血栓和止血学会定义的大出血、(2)需要医疗关注的临床相关非大出血和(3)不需要医疗关注的滋扰性出血(如瘀伤、痔疮出血)。9743名纳入到ORBIT-AF且有随访数据的患者中,两年首次出血的类型分别为:510人(3.23/100人-年)出现大出血,615人(3.90/100人-年)临床相关非大出血,1558人(9.87/100人-年)出现滋扰性出血。约1/3的患者(31.6%)大出血事件后停止OAC治疗,12.7%的患者在临床相关非大出血后停用,4.5%的患者在滋扰性出血后停用。与临床相关非大出血或滋扰性出血相比,大出血患者更可能为黑人和女性,并具有心衰史和卒中史。停用OAC的患者比继续OAC治疗的患者更可能具有中枢神经系统症状或IBD%E8%AF%8A%E6%B2%BB%E8%BF%87%E7%A8%8B%E4%B8%AD%E7%9A%84%E8%AF%84%E4%BC%B0-Part%203" target="_blank">胃肠道出血。

结论:总体来说,1/3出现大出血的患者在事件后不再抗凝。停用OAC的患者比继续OAC的患者更可能具有中枢神经系统症状或IBD%E8%AF%8A%E6%B2%BB%E8%BF%87%E7%A8%8B%E4%B8%AD%E7%9A%84%E8%AF%84%E4%BC%B0-Part%203" target="_blank">胃肠道出血。

原始出处

O'Brien EC, et al. Therapeutic Strategies Following Major, Clinically Relevant Nonmajor, and Nuisance Bleeding in Atrial Fibrillation: Findings From ORBIT-AF. J Am Heart Assoc. 2018 Jun 9;7(12). pii: e006391. doi: 10.1161/JAHA.117.006391.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1267888, encodeId=c311126e8889b, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316155, encodeId=060a13161557d, content=<a href='/topic/show?id=7a1c4360e6e' target=_blank style='color:#2F92EE;'>#大出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43607, encryptionId=7a1c4360e6e, topicName=大出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aad0444, createdName=cmsvly, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614467, encodeId=747e161446ec8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337584, encodeId=434533e584e5, content=谢谢分享学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Aug 09 23:06:00 CST 2018, time=2018-08-09, status=1, ipAttribution=)]
    2018-08-11 zhaohui6731
  2. [GetPortalCommentsPageByObjectIdResponse(id=1267888, encodeId=c311126e8889b, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316155, encodeId=060a13161557d, content=<a href='/topic/show?id=7a1c4360e6e' target=_blank style='color:#2F92EE;'>#大出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43607, encryptionId=7a1c4360e6e, topicName=大出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aad0444, createdName=cmsvly, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614467, encodeId=747e161446ec8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337584, encodeId=434533e584e5, content=谢谢分享学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Aug 09 23:06:00 CST 2018, time=2018-08-09, status=1, ipAttribution=)]
    2018-08-11 cmsvly
  3. [GetPortalCommentsPageByObjectIdResponse(id=1267888, encodeId=c311126e8889b, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316155, encodeId=060a13161557d, content=<a href='/topic/show?id=7a1c4360e6e' target=_blank style='color:#2F92EE;'>#大出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43607, encryptionId=7a1c4360e6e, topicName=大出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aad0444, createdName=cmsvly, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614467, encodeId=747e161446ec8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337584, encodeId=434533e584e5, content=谢谢分享学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Aug 09 23:06:00 CST 2018, time=2018-08-09, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1267888, encodeId=c311126e8889b, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316155, encodeId=060a13161557d, content=<a href='/topic/show?id=7a1c4360e6e' target=_blank style='color:#2F92EE;'>#大出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43607, encryptionId=7a1c4360e6e, topicName=大出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aad0444, createdName=cmsvly, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614467, encodeId=747e161446ec8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sat Aug 11 13:50:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337584, encodeId=434533e584e5, content=谢谢分享学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Aug 09 23:06:00 CST 2018, time=2018-08-09, status=1, ipAttribution=)]
    2018-08-09 清风拂面

    谢谢分享学习

    0

相关资讯

产科大出血患者术中发生肺水肿一例

患者,女,32岁,体质量64kg

Crit Care:早期纤维蛋白原浓缩物,治疗外伤性大出血的理想选择?

2018年6月,发表在《Crit Care》的一项由英国学者进行的多中心、随机、双盲、安慰剂对照试验,考察了早期纤维蛋白原浓缩物治疗外伤性大出血(E-FIT 1)的有效性。

Blood:凝血酶原复合物治疗利伐沙班或阿哌沙班相关大出血是否有效?

利伐沙班和阿哌沙班是Xa因子直接抑制剂,它们已被许多国家批准用于房颤患者的卒中预防(SPAF)以及静脉血栓栓塞症(VTE)的预防和管理。值得注意的是,出血是使用抗凝剂治疗的严重并发症,2017年10月,发表在《Blood》的一项由瑞典、澳大利亚和加拿大科学家进行的研究,考察了凝血酶原复合物(PCCs)用于利伐沙班或阿哌沙班相关大出血的治疗效果。

Plos med:剖腹产时常规进行自体血回收并不能明显降低对异体血的需求。

剖腹产大出血时常需要异体输血。血细胞回收或许可以减少这一需求。研究人员在多个妇产中心进行一实际性的随机对照试验,2013年6月4日-2016年4月17日招募有出血风险的行剖腹产的女性,与标准治疗(对照组)相比,评估常规进行细胞回收利用(干预组)的效果。在意向治疗分析中,利用多变量模型,并根据分层变量和预后因素进行校准,比较两组异体输血的概率(主要评估指标)和分娩RhD阳性的胎儿的RhD阴性的母亲母

2018 BSH指南:大出血管理中粘弹性止血试验的应用

2018年8月,英国血液病学学会(BSH)发布了大出血管理中粘弹性止血试验的应用指南,创伤患者大出血是导致发病和死亡的主要原因,本文主要针对大出血管理中粘弹性止血试验的应用提出指导建议。

JAHA:骨保护素与急性冠状动脉综合征患者大出血相关!

在采用双重抗血小板治疗的急性冠脉综合征患者中,骨保护素是大出血而不是缺血性心血管事件的一个独立标记。因此,高水平骨保护素可能有助于增加接受抗栓治疗的急性冠脉综合征患者出血风险增加的意识。

Baidu
map
Baidu
map
Baidu
map