Accumulation of Risk Factors Increases Risk of Thromboembolic Events in Patients With Nonvalvular Atrial Fibrillation(Clinical Investigation)

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概要

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• Background Accumulation of risk factors could increase thromboembolic event rates in patients with nonvalvular atrial fibrillation (NVAF). To validate this hypothesis, a post hoc analysis was performed to determine the relationship of risk levels and thromboembolic events in patients with NVAF from our previous prospective study. Methods and Results Risk levels were quantified using the CHADS2 index in 509 patients with NVAF (66.3±10.3 years old). One point each was given for patients with advanced age (≥75 years), hypertension, congestive heart failure, and diabetes mellitus, and 2 points, to those with prior ischemic stroke or transient ischemic attack. Patients with a CHADS2 score of 0 were classified as low risk, 1 to 2 a moderate risk and 3 or more were high risk. Because hypertrophic cardiomyopathy had emerged as an independent risk factor for thromboembolism, the original CHADS2 score was modified by adding 1 point to patients with hypertrophic cardiomyopathy. Warfarin was given to 263 patients (mean international normalized ratio (INR) at enrollment, 1.86), antiplatelets (aspirin or ticlopidine) to 163 patients and no antithrombotic therapy to 83. During a mean follow-up period of 2 years, 31 thromboembolic events occurred. As the risk level (modified CHADS2 score) increased, the event rate increased for both the patient groups receiving warfarin (p=0.035) and those not receiving warfarin (p=0.048). When a thromboembolic event occurred in patients who had been treated with warfarin, the mean INR level was 1.41. Twelve (75%) of 16 patients complicated with thromboembolism during warfarin treatment had INR levels below the optimal levels (1.6-2.6) for Japanese patients. Conclusion Accumulation of risk factors could increase risk of thromboembolic events in patients with NVAF. Adherence to the guidelines for anticoagulation therapy is recommended.

• 社団法人日本循環器学会の論文
• 2006-05-20

著者

• NOZAWA Takashi

  Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama

• INOUE Hiroshi

  Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama

• Hirai Tadakazu

  Second Department of Internal Medicine, University of Toyama

• LEE Jong-Dae

  First Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui

• Nozawa Takashi

  Second Department Of Internal Medicine Graduate School Of Medicine University Of Toyama

• Lee Jong-dae

  First Department Of Internal Medicine Faculty Of Medical Sciences University Of Fukui

• Lee Jong-dae

  First Department Of Internal Medicine Fukui University

• Okumura Ken

  Department Of Cardiology Respiratory Medicine And Nephrology Hirosaki University Graduate School Of

• Okumura Ken

  Second Department Of Internal Medicine Hirosaki University

• Shimizu Akihiko

  Faculty of health Sciences, Yamaguchi University School of Medicine

• Shimizu Akihiko

  Faculty Of Health Science Yamaguchi University School Of Medicine

• Okamura Kazuki

  Division Of Cardiology Niigata University Graduate School Of Medical & Dental Sciences

• Yano Katsusuke

  Department Of Cardiovascular Medicine Course Of Medical And Dental Sciences Graduate School Of Biome

• Yano Katsusuke

  長崎大学 第3内科

• Hayano Motonobu

  Third Department Of Internal Medicine Nagasaki University

• Iwasa Atsushi

  Second Department of Internal Medicine, Hirosaki University

• Yano Katsusuke

  Third Department of Internal Medicine, Nagasaki University

• Iwasa Atsushi

  Second Department Of Internal Medicine Hirosaki University

• Hirai Tadakazu

  Second Department Of Internal Medicine University Of Toyama

• Okumura Ken

  Division Of Cardiology Hirosaki University School Of Medicine

• Hirai Tadakazu

  The 2nd Department Of Internal Medicine Toyama Medical And Pharmaceutical University

• Inoue Hiroshi

  Second Department Of Internal Medicine Graduate School Of Medicine University Of Toyama

• Inoue Hiroki

  Department Of Chemistry Faculty Of Science Kyushu University

• Hirai Tadakazu

  University of Toyama

• Hayano Motonobu

  The Third Department Of Internal Medicine. Nagasaki University School Of Medicine

• Shimizu Akihiko

  Division Of Cardiovascular Medicine Department Of Medical Bioregulation Yamaguchi University School

• Yano Katsusuke

  Cardiovascular Medicine Course Of Medical And Dental Sciences Graduate School Of Biomedical Sciences

• Yano Katsusuke

  Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Yano Katsusuke

  The Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Yano Katsusuke

  Third Department Of Internal Medicine Nagasaki University

• Shimizu Akihiko

  Department Of Nursing Yamaguchi University School Of Medicine

• Yano Katsusuke

  Department Of Cardiovacular Medicine Nagasaki University

• Yano Katsusuke

  Faculty Of Health Management Nagasaki International University

• Shimizu Akihiko

  Division Of Cardiology And Faculty Of Health Sciences Yamaguchi University Graduated School Of Medic

• Shimizu Akihiko

  Department Of Cardiovascular Medicine Yamaguchi University Graduate School Of Medicine

• Hayano Motonobu

  The 3rd Department Of Internal Medicine Nagasaki University School Of Medicine

• Hayano Motonobu

  Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Shimizu Akihiko

  Faculty Of Health Sience Yamaguchi University Graduated School Of Medicine

• Yano Katsusuke

  Department Of Cardiovascular Medicine Course Of Medical And Dental Sciences Graduate School Of Biome

• Yano Katsusuke

  Department Of Cardiovascular Medicine Course Of Medical And Dental Sciences Graduate School Of Biome

• Yano Katsusuke

  Cardiovascular Medicine Course Of Medical And Dental Sciences Graduate School Of Biomedical Sciences

• Iwasa Atsushi

  Second Department Of Internal Medicine

• Hirai Tadakazu

  Second Department Of Internal Medicine Graduate School Of Medicine University Of Toyama

• Shimizu Akihiko

  Faculty Of Health Science Yamaguchi University Graduate School Of Medicine

• Shimizu Akihiko

  Faculty Of Health Science Yamaguchi University

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