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Circulation：口服抗凝药暂停后 不宜用桥接抗凝？

2014-12-18 高晓方 译 医学论坛网

口服抗凝药桥接抗凝
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美国一项研究表明，暂时中断口服抗凝药(OAC)治疗的患者约有1/4接受桥接(Bridging)抗凝治疗，并且桥接抗凝治疗与出血和不良事件风险升高相关。论文12月12日在线发表于《循环》(Circulation)。 此项前瞻性观察研究为ORBIT-AF，共纳入7372例接受OAC治疗的房颤患者，并记录了因手术而暂时中断OAC治疗的情况，其中包括桥接抗凝治疗的应用和类型。转归指标包括30天内心梗、卒

美国一项研究表明，暂时中断口服抗凝药(OAC)治疗的患者约有1/4接受桥接(Bridging)抗凝治疗，并且桥接抗凝治疗与出血和不良事件风险升高相关。论文12月12日在线发表于《循环》(Circulation)。

此项前瞻性观察研究为ORBIT-AF，共纳入7372例接受OAC治疗的房颤患者，并记录了因手术而暂时中断OAC治疗的情况，其中包括桥接抗凝治疗的应用和类型。转归指标包括30天内心梗、卒中或系统栓塞、大出血、病因特异性住院和死亡发生率。中位随访时间为2年。

 结果显示，在随访期间至2年的2200例(30%)患者中，共发生2803起OAC中断事件，其中665例(24%)应用桥接抗凝治疗，主要为低分子量肝素和普通肝素。桥接治疗者更有可能既往有脑血管事件和机械瓣膜置换，但在CHA2DS2-VASc评分方面无显著差异。

过渡治疗者的出血事件较非过渡治疗者更为常见(P<0.0001)，30天内心梗、卒中或系统栓塞、大出血、住院和死亡发生率亦显著升高(13%对6.3%，校正OR值为1.94，P=0.0001)。

原始出处

Steinberg BA1, Peterson ED2, Kim S3, Thomas L3, Gersh BJ4, Fonarow GC5, Kowey PR6, Mahaffey KW7, Sherwood MW2, Chang P8, Piccini JP2, Ansell J9; on behalf of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators and Patients.Use and Outcomes Associated with Bridging During Anticoagulation Interruptions in Patients with Atrial Fibrillation: Findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).Circulation. 2014 Dec 12.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1991931, encodeId=2049199193169, content=<a href='/topic/show?id=36ba6238527' target=_blank style='color:#2F92EE;'>#桥接抗凝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62385, encryptionId=36ba6238527, topicName=桥接抗凝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ba58436, createdName=马龙, createdTime=Tue Jun 30 18:07:00 CST 2015, time=2015-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13341, encodeId=135c13341fd, content=桥接抗凝有风险, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc1609458, createdName=2012GMxl, createdTime=Mon Dec 22 22:26:00 CST 2014, time=2014-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377356, encodeId=b85a13e735668, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Sat Dec 20 01:07:00 CST 2014, time=2014-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13256, encodeId=519d132563f, content=暂时中断口服抗凝药(OAC)治疗的患者约有1/4接受桥接(Bridging)抗凝治疗，并且桥接抗凝治疗与出血和不良事件风险升高相关。, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=870092288, createdName=rosa00tong, createdTime=Fri Dec 19 06:36:00 CST 2014, time=2014-12-19, status=1, ipAttribution=)]
    2015-06-30 马龙

    #桥接抗凝#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1991931, encodeId=2049199193169, content=<a href='/topic/show?id=36ba6238527' target=_blank style='color:#2F92EE;'>#桥接抗凝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62385, encryptionId=36ba6238527, topicName=桥接抗凝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ba58436, createdName=马龙, createdTime=Tue Jun 30 18:07:00 CST 2015, time=2015-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13341, encodeId=135c13341fd, content=桥接抗凝有风险, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc1609458, createdName=2012GMxl, createdTime=Mon Dec 22 22:26:00 CST 2014, time=2014-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377356, encodeId=b85a13e735668, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Sat Dec 20 01:07:00 CST 2014, time=2014-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13256, encodeId=519d132563f, content=暂时中断口服抗凝药(OAC)治疗的患者约有1/4接受桥接(Bridging)抗凝治疗，并且桥接抗凝治疗与出血和不良事件风险升高相关。, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=870092288, createdName=rosa00tong, createdTime=Fri Dec 19 06:36:00 CST 2014, time=2014-12-19, status=1, ipAttribution=)]
    2014-12-22 2012GMxl

    桥接抗凝有风险

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1991931, encodeId=2049199193169, content=<a href='/topic/show?id=36ba6238527' target=_blank style='color:#2F92EE;'>#桥接抗凝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62385, encryptionId=36ba6238527, topicName=桥接抗凝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ba58436, createdName=马龙, createdTime=Tue Jun 30 18:07:00 CST 2015, time=2015-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13341, encodeId=135c13341fd, content=桥接抗凝有风险, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc1609458, createdName=2012GMxl, createdTime=Mon Dec 22 22:26:00 CST 2014, time=2014-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377356, encodeId=b85a13e735668, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Sat Dec 20 01:07:00 CST 2014, time=2014-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13256, encodeId=519d132563f, content=暂时中断口服抗凝药(OAC)治疗的患者约有1/4接受桥接(Bridging)抗凝治疗，并且桥接抗凝治疗与出血和不良事件风险升高相关。, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=870092288, createdName=rosa00tong, createdTime=Fri Dec 19 06:36:00 CST 2014, time=2014-12-19, status=1, ipAttribution=)]
    2014-12-20 hunizi005

    #口服抗凝药#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1991931, encodeId=2049199193169, content=<a href='/topic/show?id=36ba6238527' target=_blank style='color:#2F92EE;'>#桥接抗凝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62385, encryptionId=36ba6238527, topicName=桥接抗凝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ba58436, createdName=马龙, createdTime=Tue Jun 30 18:07:00 CST 2015, time=2015-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13341, encodeId=135c13341fd, content=桥接抗凝有风险, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc1609458, createdName=2012GMxl, createdTime=Mon Dec 22 22:26:00 CST 2014, time=2014-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377356, encodeId=b85a13e735668, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Sat Dec 20 01:07:00 CST 2014, time=2014-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13256, encodeId=519d132563f, content=暂时中断口服抗凝药(OAC)治疗的患者约有1/4接受桥接(Bridging)抗凝治疗，并且桥接抗凝治疗与出血和不良事件风险升高相关。, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=870092288, createdName=rosa00tong, createdTime=Fri Dec 19 06:36:00 CST 2014, time=2014-12-19, status=1, ipAttribution=)]
    2014-12-19 rosa00tong

    暂时中断口服抗凝药(OAC)治疗的患者约有1/4接受桥接(Bridging)抗凝治疗，并且桥接抗凝治疗与出血和不良事件风险升高相关。

    0

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