中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2013年
11期
927-930
,共4页
心房颤动%脑血管意外%出血%老年人
心房顫動%腦血管意外%齣血%老年人
심방전동%뇌혈관의외%출혈%노년인
Atrial fibrillation%Cerebrovascular accident%Haemorrhage%Aged
目的 探讨高龄老年心房颤动(房颤)人群中卒中/出血相关临床事件与年龄增加的关系.方法 220例高龄老年房颤患者,平均年龄(83.1±0.6)岁,随访(3.2±0.8)年.结果 卒中风险CHADS2、CHA2DS2-VASc评分及出血风险HAS-BLED评分均随龄增加,在65 ～ 79岁组、80 ～ 89岁组及≥90岁组,CHA2DS2-VASc和HAS-BLED评分分别为:2.9±0.2、5.2±0.2及5.6±0.2,P＜0.001;2.1 ±0.1、3.2±0.1及3.6±0.1,P＜0.001 .与老龄房颤患者相比,高高龄老年患者大出血风险增加,接近卒中风险(80～ 89岁组:HAS-BLED相关出血风险3.7％,CHA2DS2-VASc相关卒中风险6.7％;≥90岁组:出血风险8.7％,卒中风险9.8％).此外,与CHADS2相比,CHA2DS2-VASc结合HAS-BLED评分更好地识别双重风险患者.在220例患者中,12例(5.5％)发生“双向事件”(血栓及出血事件),其中9例(75％)患者出血后再发血栓,死亡2例(22.2％).结论 高龄老年房颤患者出现出血风险随龄增加,接近卒中风险;高龄老年房颤患者易发生“双向事件”(血栓及出血),预后差,需优化抗栓管理.
目的 探討高齡老年心房顫動(房顫)人群中卒中/齣血相關臨床事件與年齡增加的關繫.方法 220例高齡老年房顫患者,平均年齡(83.1±0.6)歲,隨訪(3.2±0.8)年.結果 卒中風險CHADS2、CHA2DS2-VASc評分及齣血風險HAS-BLED評分均隨齡增加,在65 ～ 79歲組、80 ～ 89歲組及≥90歲組,CHA2DS2-VASc和HAS-BLED評分分彆為:2.9±0.2、5.2±0.2及5.6±0.2,P＜0.001;2.1 ±0.1、3.2±0.1及3.6±0.1,P＜0.001 .與老齡房顫患者相比,高高齡老年患者大齣血風險增加,接近卒中風險(80～ 89歲組:HAS-BLED相關齣血風險3.7％,CHA2DS2-VASc相關卒中風險6.7％;≥90歲組:齣血風險8.7％,卒中風險9.8％).此外,與CHADS2相比,CHA2DS2-VASc結閤HAS-BLED評分更好地識彆雙重風險患者.在220例患者中,12例(5.5％)髮生“雙嚮事件”(血栓及齣血事件),其中9例(75％)患者齣血後再髮血栓,死亡2例(22.2％).結論 高齡老年房顫患者齣現齣血風險隨齡增加,接近卒中風險;高齡老年房顫患者易髮生“雙嚮事件”(血栓及齣血),預後差,需優化抗栓管理.
목적 탐토고령노년심방전동(방전)인군중졸중/출혈상관림상사건여년령증가적관계.방법 220례고령노년방전환자,평균년령(83.1±0.6)세,수방(3.2±0.8)년.결과 졸중풍험CHADS2、CHA2DS2-VASc평분급출혈풍험HAS-BLED평분균수령증가,재65 ～ 79세조、80 ～ 89세조급≥90세조,CHA2DS2-VASc화HAS-BLED평분분별위:2.9±0.2、5.2±0.2급5.6±0.2,P＜0.001;2.1 ±0.1、3.2±0.1급3.6±0.1,P＜0.001 .여노령방전환자상비,고고령노년환자대출혈풍험증가,접근졸중풍험(80～ 89세조:HAS-BLED상관출혈풍험3.7％,CHA2DS2-VASc상관졸중풍험6.7％;≥90세조:출혈풍험8.7％,졸중풍험9.8％).차외,여CHADS2상비,CHA2DS2-VASc결합HAS-BLED평분경호지식별쌍중풍험환자.재220례환자중,12례(5.5％)발생“쌍향사건”(혈전급출혈사건),기중9례(75％)환자출혈후재발혈전,사망2례(22.2％).결론 고령노년방전환자출현출혈풍험수령증가,접근졸중풍험;고령노년방전환자역발생“쌍향사건”(혈전급출혈),예후차,수우화항전관리.
Objective The relationship between stroke/thromboembolic events (TEs) and bleeding as well as age-related risk factors are not fully clear in elderly patients with atrial fibrillation (AF).This study aimed to evaluate the clinical features,incidence and risk factors of stroke and bleeding in elderly AF patients.Method A total of 220 elderly AF patients [mean age (83.1 ± 0.6) years] were followed for (3.2 ± 0.8)years.The CHA2DS2-VASc score,the HAS-BLED score,annual major bleeding risk and the annual stroke were analyzed.Result The CHA2DS2-VASc score in patients with 65-79,80-89 and ≥90 years old groups were 2.9 ± 0.2,5.2 ± 0.2 and 5.6 ± 0.2,respectively (P ＜ 0.001) and the HASBLED score were 2.1 ±0.1,3.2 ±0.1 and 3.6 ±0.1,respectively (P ＜0.001),both significantly increased with aging.The annual major bleeding risk increased similarly as the annual stroke risk in the very elderly AF patients (patients 80-89 years old:bleeding risk 3.7 ％,stroke risk 6.7 ％ ; patients ≥ 90 years old:8.7 ％ and 9.8 ％,respectively).The combination of CHA2DS2-VASc and HAS-BLED could identify those patients with high risk for stroke and bleeding correctly.Twelve (5.5％) patients experienced "bidirectional events" (concomitant TE and haemorrhage),of whom 9 (75.0 ％) suffered recurrent TEs.Conclusion The bleeding risk increased similarly as the thromboembotic risk with increasing age in the elderly AF patients,"bidirectional events" is not common but related with worse outcome in elderly AF patients.
