■口服抗凝药(OACs)抗血栓治疗对合并有急性冠脉综合征(ACS)和心房颤动(AF)的老年患者的疗效和安全性尚不清楚。
■连续招募一组被诊断为ACS和AF并接受口服抗血栓药物治疗的住院老年患者(年龄≥65岁)。随访至少1年。主要不良心脏事件(MACE)定义为全因死亡的复合,非致死性心肌梗死(MI),非致命性中风,和全身性栓塞.根据出血学术研究联盟(BARC)标准定义出血的安全性结果。
■分析了548名合格患者(76±6.6岁)的队列。与接受OAC治疗的患者相比(n=184,33.6%),未接受OAC治疗的患者(n=364,66.4%)年龄较大,持续性房颤和不稳定型心绞痛(UA)的患病率较低,更常见的是阵发性房颤,急性心肌梗死(AMI),支架植入和双重抗血小板治疗(DAPT)。与未接受OAC治疗的患者相比(n=364,66.4%),接受OAC治疗的患者(n=184,33.6%)在1年的MACE风险均较低(4.3vs.15.1%,调整后的HR:0.34,95%CI:0.15-0.80,p=0.014)和5年(17.5与48.4%,调整后的HR:0.36,95%CI:0.19-0.67,p=0.001)随访。两组间BARC≥2的出血事件无显著差异(8.0vs.9.0%,调整后的HR:1.17,95%CI:0.58-2.34,p=0.667)。与华法林治疗的患者相比,非维生素K拮抗剂口服抗凝药治疗的患者全因死亡率风险较低(2.1vs.9.5%,HR:0.18,95%CI:0.03-0.98,p=0.047)和BARC≥3的出血事件(2.1vs.4.8%,HR:0.14,95%CI:0.02-1.10,p=0.062)。
■在老年ACS和AF患者中,OAC抗血栓治疗与缺血事件风险降低相关,而出血事件不增加。在现实世界的实践中,老年ACS和AF患者抗凝治疗的临床意识有待加强。
UNASSIGNED: The efficacy and safety of antithrombotic treatment with oral anticoagulants (OACs) in elderly patients with comorbidities of acute coronary syndrome (ACS) and atrial fibrillation (AF) are unclear.
UNASSIGNED: A cohort of hospitalized elderly patients (≥65 years of age) diagnosed with ACS and AF and treated with oral antithrombotic agents were consecutively recruited. Follow-up was performed for at least 1 year. Major adverse cardiac events (MACEs) were defined as a composite of all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, and systemic embolism. The safety outcomes of bleeding were defined according to the Bleeding Academic Research Consortium (BARC) criteria.
UNASSIGNED: A cohort of 548 eligible patients (76 ± 6.6 years) was analyzed. Compared to the patients with OAC treatment (n = 184, 33.6%), patients treated without OAC (n = 364, 66.4%) were older, had a lower prevalence of persistent AF and unstable angina (UA), and more often presented with paroxysmal AF, acute myocardial infarction (AMI), stent implantation and dual antiplatelet therapy (DAPT). Compared to the patients without OAC treatment (n = 364, 66.4%), patients treated with OAC (n = 184, 33.6%) had a lower risk of MACEs at both the 1-year (4.3 vs. 15.1%, adjusted HR: 0.34, 95% CI: 0.15-0.80, p = 0.014) and 5-year (17.5 vs. 48.4%, adjusted HR: 0.36, 95% CI: 0.19-0.67, p = 0.001) follow-up. No significant difference was observed for bleeding events of BARC ≥2 between the groups (8.0 vs. 9.0%, adjusted HR: 1.17, 95% CI: 0.58-2.34, p = 0.667). Compared with warfarin-treated patients, the non-vitamin K antagonist oral anticoagulant-treated patients had lower risks of all-cause mortality (2.1 vs. 9.5%, HR: 0.18, 95% CI: 0.03-0.98, p = 0.047) and bleeding events of BARC ≥ 3 (2.1 vs. 4.8%, HR: 0.14, 95% CI: 0.02-1.10, p = 0.062).
UNASSIGNED: Antithrombotic therapy with OACs in elderly patients with ACS and AF was associated with a lower risk of ischemic events without an increase in bleeding events. In real-world practice, the clinical awareness of anticoagulation treatments in elderly patients with ACS and AF needs to be strengthened.