Tom 18, Nr 1 (2021)
Artykuł przeglądowy
Opublikowany online: 2021-05-27
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Leczenie przeciwkrzepliwe w ramach profilaktyki udaru niedokrwiennego u osób starszych z migotaniem przedsionków.
Choroby Serca i Naczyń 2021;18(1):20-26.
Streszczenie
Migotanie przedsionków (AF) jest najczęstszym rodzajem arytmii, jego częstość występowania szacuje się na 1–4% w populacji ogólnej, a znaczna większość chorych to osoby powyżej 65 lat. Wiek i choroby współistniejące zwiększają ryzyko zarówno krwawienia, jak i powikłań zakrzepowo-zatorowych, natomiast sama obecność AF jest związana z 5-krotnym wzrostem ryzyka udaru niedokrwiennego. Jednocześnie wśród chorych starszych z AF często obserwuje się zaniechanie terapii przeciwkrzepliwej ze względu na liczne choroby towarzyszące i powikłania leczenia. Dostępne obecnie metody prewencji udaru niedokrwiennego, preparaty oraz schematy dawkowania umożliwiają jednak skuteczne leczenie nawet najbardziej wymagających chorych.
Słowa kluczowe: migotanie przedsionkówudarosoby starszeantykoagulacja
Referencje
- Zulkifly H, Lip GYH, Lane DA. Epidemiology of atrial fibrillation. Int J Clin Pract. 2018; 72(3): e13070.
- Zoni-Berisso M, Lercari F, Carazza T, et al. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol. 2014; 6: 213–220.
- Benjamin EJ. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994; 271(11): 840–844.
- Furberg CD, Psaty BM, Manolio TA, et al. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol. 1994; 74(3): 236–241.
- Hindricks G, Potpara T, Dagres N, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021; 42(5): 373–498.
- Steger C, Pratter A, Martinek-Bregel M, et al. Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke registry. Eur Heart J. 2004; 25(19): 1734–1740.
- Wang TJ, Massaro JM, Levy D, et al. A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study. JAMA. 2003; 290(8): 1049–1056.
- Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Arch Inter Med. 1994; 154(13): 1449–1457.
- Fohtung RB, Rich MW. Identification of patients at risk of stroke from atrial fibrillation. US Cardiology Review. 2016; 10(2): 60–64.
- Hylek EM, Regan S, Go AS, et al. Clinical predictors of prolonged delay in return of the international normalized ratio to within the therapeutic range after excessive anticoagulation with warfarin. Ann Intern Med. 2001; 135(6): 393–400.
- Guo Qi, Du X, Ma CS. Atrial fibrillation and frailty. J Geriatr Cardiol. 2020; 17(2): 105–109.
- Connolly SJ, Ezekowitz MD, Yusuf S, et al. RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009; 361(12): 1139–1151.
- Halperin JL, Hankey GJ, Wojdyla DM, et al. ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365(10): 883–891.
- Granger CB, Alexander JH, McMurray JJV, et al. ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365(11): 981–992.
- Giugliano RP, Ruff CT, Braunwald E, et al. ENGAGE AF-TIMI 48 Investigators. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013; 369(22): 2093–2104.
- Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014; 383(9921): 955–962.
- Pollack CV, Reilly PA, van Ryn J, et al. Idarucizumab for dabigatran reversal - full cohort analysis. N Engl J Med. 2017; 377(5): 431–441.
- Fauchier L, Blin P, Sacher F, et al. Reduced dose of rivaroxaban and dabigatran vs. vitamin K antagonists in very elderly patients with atrial fibrillation in a nationwide cohort study. Europace. 2020; 22(2): 205–215.
- Schneeweiss S, Gagne JJ, Patrick AR, et al. Comparative efficacy and safety of new oral anticoagulants in patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2012; 5(4): 480–486.
- Schneeweiss S, Gagne JJ, Patrick AR, et al. Comparative efficacy and safety of new oral anticoagulants in patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2012; 5(4): 480–486.
- Fox M. Cash-strapped US Patients may be skipping drugs. http://www reuters com/article/healthNews/idUSTRE5196SR20090211 (February 1, 2021).
- Diener HC, Weber R, Lip GYH, et al. Stroke prevention in atrial fibrillation: do we still need warfarin? Curr Opin Neurol. 2012; 25(1): 27–35.
- Singla DL, Morrill GB. Warfarin maintenance dosages in the very elderly. Am J Health Syst Pharm. 2005; 62(10): 1062–1066.
- Ogilvie IM, Newton N, Welner SA, et al. Underuse of oral anticoagulants in atrial fibrillation: a systematic review. Am J Med. 2010; 123(7): 638–645.e4.
- Wan Yi, Heneghan C, Perera R, et al. Anticoagulation control and prediction of adverse events in patients with atrial fibrillation: a systematic review. Circ Cardiovasc Qual Outcomes. 2008; 1(2): 84–91.
- Martin A, Siegal D, Verbrugge F, et al. Why do clinicians withhold anticoagulation in patients with atrial fibrillation and CHA2DS2-VASc score ≥ 2? Arch Cardiovasc Dis Suppl. 2019; 11(1): 83–84.
- Hylek EM, D'Antonio J, Evans-Molina C, et al. Translating the results of randomized trials into clinical practice: the challenge of warfarin candidacy among hospitalized elderly patients with atrial fibrillation. Stroke. 2006; 37(4): 1075–1080.
- Själander S, Själander A, Svensson PJ, et al. Atrial fibrillation patients do not benefit from acetylsalicylic acid. Europace. 2014; 16(5): 631–638.
- Mant J, Hobbs F, Fletcher K, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. The Lancet. 2007; 370(9586): 493–503.
- Lip GYH. The role of aspirin for stroke prevention in atrial fibrillation. Nat Rev Cardiol. 2011; 8(10): 602–606.
- Patti G, Pengo V, Marcucci R, et al. Working Group of Thrombosis of the Italian Society of Cardiology. The left atrial appendage: from embryology to prevention of thromboembolism. Eur Heart J. 2017; 38(12): 877–887.
- Fountain RB, Holmes DR, Chandrasekaran K, et al. The PROTECT AF (WATCHMAN left atrial appendage system for embolic PROTECTion in patients with atrial fibrillation) trial. Am Heart J. 2006; 151(5): 956–961.
- Holmes DR, Kar S, Price MJ, et al. Prospective randomized evaluation of the watchman left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014; 64(1): 1–12.
- Holmes DR, Doshi SK, Kar S, et al. Left atrial appendage closure as an alternative to warfarin for stroke prevention in atrial fibrillation: a patient-level meta-analysis. J Am Coll Cardiol. 2015; 65(24): 2614–2623.
- Cruz-González I, Ince H, Kische S, et al. Left atrial appendage occlusion in patients older than 85 years. Safety and efficacy in the EWOLUTION registry. Rev Esp Cardiol (Engl Ed). 2020; 73(1): 21–27.
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