弥合差距:解决老年房颤患者跌倒后抗凝使用不足的问题

Q4 Medicine
Musa Bin Bashir , Jeyasundar Dhevenbu , Zhi Quan Wang
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引用次数: 0

摘要

老年患者跌倒后开始或停止抗凝治疗的选择是一个主要的临床挑战,因为跌倒会增加出血的风险。然而,抗凝对于房颤(AF)患者来说是必不可少的,以防止血栓栓塞事件,对出血和偏见的担忧可能导致抗凝剂的处方。该研究于2019年9月至2023年10月进行,检查了年龄为>;50年住院房颤患者,目的是确定影响抗凝处方的因素。方法所有患者住院期间均有跌倒经历。值得注意的是,这些跌倒并不是入院的原因。结果在327例患者中,210例(64.2%)出院后接受抗凝治疗,79.5%接受非维生素K拮抗剂口服抗凝治疗。心脏病咨询与男性参与者之间存在显著关联(P <;.001), 65-74岁(P <;.001),有健康保险的人(P = .001)。65 ~ 74岁患者(P <;.001)、农村居住(P = .03)、独立行走(P <;.001)和健康保险(P <;.001)与抗凝放电显著相关。结论:与预期相反,有意外跌倒史的房颤住院患者开始口服抗凝的决定主要不是基于CHA2DS2-VASc等风险量表,而是基于其他临床、社会和医疗覆盖条件。这强调了需要更细致地了解影响这一弱势群体抗凝决策的因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Bridging the gap: Addressing anticoagulation underutilization in elderly atrial fibrillation patients post-fall

Introduction and objectives

The choice to start or stop anticoagulation therapy in elderly patients post-fall is a major clinical challenge because falls increase the risk of bleeding. However, anticoagulation is essential in patients with atrial fibrillation (AF) to prevent thromboembolic events, and concerns about bleeding and bias may result in the prescription of anticoagulants. This study, conducted from September 2019 to October 2023, examined patients aged > 50 years with AF who fell in-hospital, with the aim of identifying influencing anticoagulant prescriptions.

Methods

All the patients included in the study experienced falls during hospitalization. It is important to note that these falls were not a reason for admission.

Results

Out of the 327 patients in the study, 210 (64.2%) were discharged on anticoagulation therapy, and 79.5% received non-vitamin K antagonist oral anticoagulants. Significant associations were found between cardiology consultations and male participants (P < .001), those aged 65–74 (P < .001), and those with health insurance (P = .001). Patients aged 65–74 years (P < .001), rural residence (P = .03), independent ambulation (P < .001), and health insurance (P < .001) were significantly associated with anticoagulation discharge.

Conclusions

Contrary to expectations, the decision to initiate oral anticoagulation in hospitalized patients with AF and a history of accidental falls was not primarily based on risk scales such as CHA2DS2-VASc but rather on other clinical, social, and medical coverage conditions. This underscores the need for a more nuanced understanding of the factors influencing anticoagulation decisions in this vulnerable population.
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来源期刊
REC: CardioClinics
REC: CardioClinics Medicine-Cardiology and Cardiovascular Medicine
CiteScore
0.90
自引率
0.00%
发文量
79
审稿时长
33 days
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