6533b7dbfe1ef96bd12701d5
RESEARCH PRODUCT
Joint use of cardio-embolic and bleeding risk scores in elderly patients with atrial fibrillation
M MarcucciA NobiliM TettamantiA IorioL PasinaCd DjadeC FranchiA MarengoniF SalernoS CorraoF VioliPm MannucciInvestigators ReposiMm PierA NobiliM TettamantiL PasinaC FranchiF SalernoS CorraoA MarengoniA IorioM MarcucciV SpiritoD NoceJ BonazziR LombardoE SparacioS AlborghettiM TettamantiL De VittorioCd DjadeD PriscoE SilvestriC CenciT BarniniG DelitalaS CartaS AtzoriG GuarnieriM ZanettiA SpallutiMg SerraMa BleveM VanoliG GrignaniG CasellaL GasbarroneG ManiscalcoM GunelliD TirottaA BrucatoS GhidoniP Di CoratoM BernardiS Li BassiL SantiG AgnelliA IorioM MarcucciE MarchesiniE MannarinoG LupattelliP RondelliF PaciulloF FabrisM CarlonF TurattoMc BaroniM ZardoR ManfrediniC MolinoM PalaF FabbianR NutiR ValentiM RuvioS CappelliG PaolissoMr RizzoMt LaietaT SalvatoreFc SassoR UtiliE Durante MangoniD PintoO OlivieriAm StanzialR FellinS VolpatoS FotiniM BarbagalloL DominguezL PlancesD D'angeloG RiniP MansuetoI PepeG LicataL CalvoM ValentiC BorghiE StrocchiEr RinaldiM ZoliE FabbriD MagalottiA AuteriAl PasquiL PuccettiFl PasiniPl CapecchiM BicchiC SabbàFs VellaA MarsegliaCv LuglioG PalascianoMe ModeoA AquilinoP RaffaeleS PuglieseC CapobiancoA PostiglioneMr BarbellaF De StefanoL FenoglioC BrignoneC BraccoA GiraudoG MuscaO CuccurulloL CriccoA FiorentiniMd CappelliniG FabioS Seghezzi De Amicis MmS FargionP BonaraM BulgheroniR LombardiF MagriniF MassariT TonellaF PeyvandiA TedeschiR RossioG MoreoB FerrariL RoncariV MonzaniV SavojardoC FolliM MagniniD MariP Dionigi RossiS DamantiS ProloMs LilleriL CriccoA FiorentiniG MicaleM PoddaC SelmiF MedaF SalernoS AccordinoA ConcaV MontiGr CorazzaE MiceliMv LentiD PadulaCl BalduiniG BertolinoS ProviniF QuagliaG MurialdoM BovioF DallegriL OttonelloA QuercioliA BarrecaMb SecchiD GhelfiWs ChinL CarassaleS CaporotundoL SofiaL AnastasioM CarboneG TraisciL De FeudisS Di CarloMt GuagnanoS SestiliE BergamiE RizzioliC CagnoniL BertoneA ManucraA BurattiT TogninNl LiberatoG BernasconiB NardoGb BianchiS GiaquintoG BenettiM QuaglioloGr CentenaroFrancesco PurrelloA Di PinoSalvatore PiroG MancusoD CalipariM BartoneF GulloM CortellaroM MagentaF PeregoMr MeroniM CicardiAg MagentaA SaccoA BonelliG DentamaroR RozziniL FalangaA GiordanoPc PerinB LorenzatiG GrudenG BrunoG MontrucchioE GrecoP TizzaniG Fera Di Luca MlD RennaA PerciccanteA CoralliR TassaraD MelisL RebellaG MenardoS BottoneE SferrazzoC FerriR StriuliR ScipioniR SalmiP GaudenziS GamberiniF RicciC MorabitoR FavaA SempliciniL GottardoG DelitalaS CartaS AtzoriG VendemialeG ServiddioR ForlanoL BolondiL RascitiI SerioC MasalaA MammarellaV RaparelliF Rossi FanelliM DelfinoA AmorosoF VioliS BasiliL PerriP SerraV FontanaM FalconeR LandolfiA GriecoA GalloG ZuccalàF FranceschiG De MarcoC ChiaraS MartaM BellusciD SettiF PedrazzoliG RomanelliC PiraliC AmoliniEa RoseiD RizzoniL CastoldiA PicardiUv GentilucciC MazzarelliP GalloL GuastiL CastiglioniA MarescaA SquizzatoS ContiniM MolaroG AnnoniMc ZazzettaM BertolottiCm ScottoMa FerriF VeltriF ArturiE SuccurroG SestiU GualtieriF PerticoneA SciacquaM QueroC BagnatoP LoriaMa BecchiG MartucciA FantuzziM MaurantonioR CorinaldesiR De GiorgioM SerraV GrassoE RuggeriLm CarozzaF. Pignattisubject
RegistrieMaleEmbolismAtrial fibrillation; Bleeding risk; Cardioembolic risk; Elderly; Prediction guides; Thromboprophylaxis; Aged; Aged; 80 and over; Anticoagulants; Atrial Fibrillation; Embolism; Female; Hemorrhage; Humans; Logistic Models; Male; Platelet Aggregation Inhibitors; Retrospective Studies; Stroke; Warfarin; Registries; Risk Assessment; Internal MedicineRetrospective Studiearitmiableeding risk scoreAtrial Fibrillation80 and overatrial fibrillationRegistriesStrokeAged 80 and overAspirineducation.field_of_studyElderly Atrial fibrillation Prediction guides Bleeding risk Cardioembolic risk ThromboprophylaxisPrediction guidesAtrial fibrillationCardiovascular diseaseStrokecardio-embolic scorePlatelet aggregation inhibitorcardio-embolic scores; bleeding risk scores; elderly; Atrial FibrillationFemaleRisk assessmentmedicine.drugHumanmedicine.medical_specialtyLogistic Modelcardio-embolic scoresPopulationHemorrhageRisk AssessmentelderlyCARDIOEMBOLIC RISKNOBLEEDING RISKInternal medicinemedicineElderly; Atrial fibrillation; Prediction guides; Bleeding risk; Cardioembolic riskbleeding risk scoresPrediction guideInternal MedicineHumanseducationThromboprophylaxisAgedRetrospective StudiesELDERLYbusiness.industryPlatelet Aggregation InhibitorSettore MED/09 - MEDICINA INTERNAWarfarinAnticoagulantAnticoagulantsRetrospective cohort studyAtrial fibrillation; Bleeding risk; Cardioembolic risk; Elderly; Prediction guides; Thromboprophylaxis; Aged; Aged 80 and over; Anticoagulants; Atrial Fibrillation; Embolism; Female; Hemorrhage; Humans; Logistic Models; Male; Platelet Aggregation Inhibitors; Retrospective Studies; Stroke; Warfarin; Registries; Risk Assessment; Internal Medicinemedicine.diseaseSurgeryLogistic ModelsThromboprophylaxiWarfarinbusinessPlatelet Aggregation Inhibitorsdescription
Background Scores for cardio-embolic and bleeding risk in patients with atrial fibrillation are described in the literature. However, it is not clear how they co-classify elderly patients with multimorbidity, nor whether and how they affect the physician's decision on thromboprophylaxis. Methods Four scores for cardio-embolic and bleeding risks were retrospectively calculated for ⥠65 year old patients with atrial fibrillation enrolled in the REPOSI registry. The co-classification of patients according to risk categories based on different score combinations was described and the relationship between risk categories tested. The association between the antithrombotic therapy received and the scores was investigated by logistic regressions and CART analyses. Results At admission, among 543 patients the median scores (range) were: CHADS22 (0-6), CHA2DS2-VASc 4 (1-9), HEMORR2HAGES 3 (0-7), HAS-BLED 2 (1-6). Most of the patients were at high cardio-embolic/high-intermediate bleeding risk (70.5% combining CHADS2and HEMORR2HAGES, 98.3% combining CHA2DS2-VASc and HAS-BLED). 50-60% of patients were classified in a cardio-embolic risk category higher than the bleeding risk category. In univariate and multivariable analyses, a higher bleeding score was negatively associated with warfarin prescription, and positively associated with aspirin prescription. The cardio-embolic scores were associated with the therapeutic choice only after adjusting for bleeding score or age. Conclusion REPOSI patients represented a population at high cardio-embolic and bleeding risks, but most of them were classified by the scores as having a higher cardio-embolic than bleeding risk. Yet, prescription and type of antithrombotic therapy appeared to be primarily dictated by the bleeding risk. © 2013 European Federation of Internal Medicine.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2013-01-01 |