摘要
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.
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 I were followed for （3.2 ± 0. 8 ） years. The CHA2 DS2-VASe score, the HAS-BLED score, annual major bleeding risk and the annum 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 HAS- BLED score were 2. 1 ± 0. 1, 3.2 ± 0. 1 and 3.6 ± 0. 1, respectively （ P 〈 O. 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 CHA2 DS2-VASe 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 natients.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2013年第11期927-930,共4页
Chinese Journal of Cardiology
关键词
心房颤动
脑血管意外
出血
老年人
Atrial fibrillation
Cerebrovascular accident
Haemorrhage
Aged
