非瓣膜性心房颤动患者抗凝治疗现状和影响因素

Current application status and related factors of anticoagulation therapy in hospitalized patients with non-valvular atrial fibrillation

目的:分析非瓣膜性心房颤动(NVAF)住院患者的抗凝治疗现状和影响因素。方法:回顾性分析2017年6月至2018年6月在武汉大学中南医院住院的非瓣膜性房颤患者315例,依据CHA2DS2-VASc和HAS-BLED评分对卒中风险和出血风险进行评估,比较不同危险分层的抗凝治疗情况。结果:纳入非瓣膜性房颤患者315例,年龄(73. 76±10. 95)岁。入选病人CHA2DS2-VASc评分(3. 51±1. 66)分,卒中高危组271例(86. 0%),卒中中危组30例(9. 5%)。HAS-BLED评分(2. 25±1. 01)分,高出血风险组134例(42. 5%),低出血风险组181例(57. 5%)。卒中高危住院病人的抗凝治疗率为41. 7%,其中华法林使用率41. 6%,新型口服抗凝药(NOAC)使用率58. 4%。Logistic回归分析表明合并冠心病、射频消融术后对抗栓治疗方案的影响差异有统计学意义(P<0. 05)。结论:目前NVAF住院患者的抗凝治疗与指南推荐有一定的差距,需严格按危险分层加强抗凝药物使用。

Objective: To analyze the epidemiological status and the anticoagulation treatment and influencing factors of atrial fibrillation(AF)hospitalized patients.Methods: The clinical data and anticoagulation therapy of 315 patients with NVAF in Zhongnan Hospital of Wuhan University from June 2017 to June 2018 were retrospectively analyzed. The clinical features and anticoagulation status were analyzed based on CHA2DS2-VASc score stratification and HAS-BLED score stratification.Results:The mean age of these AF patients was(73. 76±10. 95)years old. The rate of anticoagulant therapy in hospitalized patients with high risk of stroke was 41. 7%, among which the utilization rate of warfarin was 41. 6% and the rate of new oral anticoagulant was 58. 4%. A logistic regression analysis showed that the factor of combined coronary heart disease and post-atrial fibrillation ablation had statistical significance(both P<0. 05).Conclusion: There is an certain distance between the present situation and the guideline for anticoagulation therapy in most of these patients with NVAF. Anticoagulation has not been performed by stratified risk criteria in these patients.