新发心房颤动脓毒症患者住院后使用抗凝药的实践模式和结果。

IF 6.9 2区 医学 Circulation. Cardiovascular Quality and Outcomes Pub Date : 2023-03-01 Epub Date: 2023-02-28 DOI:10.1161/CIRCOUTCOMES.122.009494
Allan J Walkey, Laura C Myers, Khanh K Thai, Patricia Kipnis, Manisha Desai, Alan S Go, Yun Lu, Heather Clancy, Ycar Devis, Romain Neugebauer, Vincent X Liu
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引用次数: 0

摘要

背景:脓毒症期间新发房颤(AF)患者住院后使用口服抗凝药预防动脉血栓栓塞的实践模式和结果尚不清楚:回顾性观察队列研究:2011 年至 2018 年,北加州凯撒医疗保健服务系统的 21 家医院对脓毒症期间新发房颤住院后存活出院的年龄≥40 岁的患者进行观察。主要结局为缺血性中风/短暂性脑缺血发作(TIA),安全结局为大出血事件,均在脓毒症住院患者出院后 1 年内发生。在目标试验仿真框架内,使用超级学习法通过反概率加权拟合边际结构模型,对出院后30天内接受和未接受口服抗凝治疗的患者之间的调整后风险差异进行了估计:在82 748名因脓毒症住院的患者中,有3 992人(4.8%)患有新发房颤并存活至出院;平均年龄为78±11岁,53%为男性,70%为白人。脓毒症期间新发房颤患者平均占遥测监测房颤患者的 45±33%,27% 的患者在出院当天出现房颤。出院 1 年内,89 名患者(2.2%)发生中风/TIA,225 名患者(5.6%)大出血,1011 名患者(25%)死亡。出院 30 天内,807 名(20%)患者开具了口服抗凝处方,这与较高的 1 年调整后缺血性中风/TIA 风险相关(5.69% 对 2.32%;风险差异为 3.37% [95% CI,0.36-6.38]),而 1 年调整后大出血风险无显著差异(6.51% 对 7.10%;风险差异为-0.59% [95% CI,-3.09 至 1.91])。仅对缺血性卒中结果进行的敏感性分析显示,风险差异为 0.15%(95% CI,-1.72 至 2.03):结论:脓毒症期间新发房颤患者住院后,口服抗凝药物并不常见,但可能与更高的卒中/TIA 风险相关。需要进一步开展研究,以了解中风和 TIA 的机制以及脓毒症后新发房颤的管理。
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Practice Patterns and Outcomes Associated With Anticoagulation Use Following Sepsis Hospitalizations With New-Onset Atrial Fibrillation.

Background: Practice patterns and outcomes associated with the use of oral anticoagulation for arterial thromboembolism prevention following a hospitalization with new-onset atrial fibrillation (AF) during sepsis are unclear.

Methods: Retrospective, observational cohort study of patients ≥40 years of age discharged alive following hospitalization with new-onset AF during sepsis across 21 hospitals in the Kaiser Permanente Northern California health care delivery system, years 2011 to 2018. Primary outcomes were ischemic stroke/transient ischemic attack (TIA), with a safety outcome of major bleeding events, both within 1 year of discharge alive from sepsis hospitalization. Adjusted risk differences for outcomes between patients who did and did not receive oral anticoagulation within 30 days of discharge were estimated using marginal structural models fitted by inverse probability weighting using Super Learning within a target trial emulation framework.

Results: Among 82 748 patients hospitalized with sepsis, 3992 (4.8%) had new-onset AF and survived to hospital discharge; mean age was 78±11 years, 53% were men, and 70% were White. Patients with new-onset AF during sepsis averaged 45±33% of telemetry monitoring entries with AF, and 27% had AF present on the day of hospital discharge. Within 1 year of hospital discharge, 89 (2.2%) patients experienced stroke/TIA, 225 (5.6%) had major bleeding, and 1011 (25%) died. Within 30 days of discharge, 807 (20%) patients filled oral anticoagulation prescriptions, which were associated with higher 1-year adjusted risks of ischemic stroke/TIA (5.69% versus 2.32%; risk difference, 3.37% [95% CI, 0.36-6.38]) and no significant difference in 1-year adjusted risks of major bleeding (6.51% versus 7.10%; risk difference, -0.59% [95% CI, -3.09 to 1.91]). Sensitivity analysis of ischemic stroke-only outcomes showed a risk difference of 0.15% (95% CI, -1.72 to 2.03).

Conclusions: After hospitalization with new-onset AF during sepsis, oral anticoagulation use was uncommon and associated with potentially higher stroke/TIA risk. Further research to inform mechanisms of stroke and TIA and management of new-onset AF after sepsis is needed.

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来源期刊
Circulation. Cardiovascular Quality and Outcomes
Circulation. Cardiovascular Quality and Outcomes Medicine-Cardiology and Cardiovascular Medicine
CiteScore
9.80
自引率
2.90%
发文量
357
期刊介绍: Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.
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