心房颤动抗凝出血风险评估进展

Bleeding Risk Scores for Anticoagulated Patients with Atrial Fibrillation

心房颤动是导致卒中、心力衰竭、猝死和其他心血管疾病的主要病因之一。心房颤动患者中,卒中导致的死亡可以通过抗凝显著减少。维生素K拮抗剂华法林的使用,受限于狭窄的治疗窗、需要频繁监测凝血指标国际标准化比值及调整药物剂量,以及出血事件,包括严重出血及无关紧要的出血、预先评估的抗凝"高出血风险",均是临床中不用或停用口服抗凝药的常见原因。非维生素K拮抗口服抗凝药在卒中预防方面显示出不劣于甚至优于华法林的效果,且显著降低出血风险。尽管如此,临床仍需重视心房颤动抗凝出血风险评估,重视识别可纠正的出血风险因子。现就心房颤动抗凝出血风险评估的研究进展做一综述。

Atrial fibrillation is one of the leading causes of stroke,heart failure,sudden death,and other cardiovascular diseases. In patients Swith atrial fibrillation,death due to stroke can be reduced significantly by anticoagulation.However,the usage of warfarin( vitamin K antagonist),is limited by the narrow therapeutic window,frequent monitoring of the blood coagulant index international normalized ratio,frequent adjustment of dosage,bleeding events,including severe bleeding and irrelevant bleeding,and pre-estimated high bleeding risk of anticoagulation.Those are the common reasons for underuse or withdrawl of anticoagulation in clinic practice.Non-vitamin K antagonist oral anticoagulants have shown non-inferior or even better efficacy than warfarin in stroke prevention,and significantly reduced the risk of bleeding.Nevertheless,we still need to attach importance to bleeding risk assessment and the recognition of modifiable risk factors for bleeding in anticoagulated patients.This article reviews the current research progress of bleeding risk scores for anticoagulated patients with atrial fibrillation.