Escalas de evaluación del riesgo tromboembólico y hemorrágico en la fibrilación auricular

Q4 Medicine
Javier Pérez-Copete , María Asunción Esteve-Pastor , Vanessa Roldán , Mariano Valdés , Francisco Marín
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引用次数: 6

Abstract

Atrial fibrillation is the most prevalent cardiac arrhythmia in the general population. Its presence increases the risk of thromboembolic events five-fold. Antithrombotic therapy reduces this risk, but increases the risk of bleeding, with intracranial bleeding being the most feared complication. However, the risk varies between patients and, as a result, various thromboembolic risk scores have been developed in recent years (e.g. the CHADS2, CHA2DS2-VASc and ATRIA scores). The CHA2DS2-VASc score is recommended by clinical practice guidelines to help optimize antithrombotic therapy in patients with atrial fibrillation. In addition, these guidelines also recommend that both thromboembolic risk and the risk of bleeding should be assessed. A number of risk models have been proposed for assessing the bleeding risk in these patients (e.g. the HEMORR2HAGES, HAS-BLED, ATRIA and ORBIT-AF scores), but currently the majority of guidelines recommend the HAS-BLED score. Above all, it is essential that the net clinical benefit of antithrombotic therapy is assessed: the expected benefit of anticoagulation therapy should outweigh the expected harm caused by possible bleeding. Nevertheless, the ability of both thromboembolic and bleeding risk scores to predict clinical events is only moderate. Consequently, alternative approaches, such as the use of biomarkers (e.g. D-dimer, von Willebrand factor and GDF-15), could help evaluate the thromboembolic risk in individual patients with atrial fibrillation.

评估房颤血栓栓塞和出血性风险的量表
心房颤动是普通人群中最常见的心律失常。它的存在使血栓栓塞事件的风险增加了5倍。抗血栓治疗降低了这种风险,但增加了出血的风险,颅内出血是最可怕的并发症。然而,不同患者的风险不同,因此,近年来开发了各种血栓栓塞风险评分(例如CHADS2, CHA2DS2-VASc和ATRIA评分)。临床实践指南推荐CHA2DS2-VASc评分,以帮助优化房颤患者的抗血栓治疗。此外,这些指南还建议对血栓栓塞风险和出血风险进行评估。已经提出了许多风险模型来评估这些患者的出血风险(例如HEMORR2HAGES、ha - bled、ATRIA和orbito - af评分),但目前大多数指南推荐使用ha - bled评分。最重要的是,评估抗血栓治疗的净临床获益是至关重要的:抗凝治疗的预期获益应超过可能出血造成的预期危害。然而,血栓栓塞和出血风险评分预测临床事件的能力只是中等。因此,替代方法,如使用生物标志物(如d -二聚体、血管性血友病因子和GDF-15),可以帮助评估心房颤动个体患者的血栓栓塞风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Revista Espanola de Cardiologia Suplementos
Revista Espanola de Cardiologia Suplementos Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.20
自引率
0.00%
发文量
1
期刊介绍: Revista Española de Cardiología, is an international scientific journal dealing with cardiovascular medicine. Revista Española de Cardiología, the official publication of the Spanish Society of Cardiology, publishes research articles related to cardiovascular diseases. Articles are published in Spanish for the paper edition and in both Spanish and English in the electronic edition, which is available on the Internet. Regular sections include original articles reporting clinical or basic research, brief reports, review articles, editorials and letters to the Editor.
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