非瓣膜病心房颤动住院患者抗凝治疗现状及影响因素分析

Anticoagulation treatment and related factors in hospitalized patients with novalvalar atrial fibrillation

目的:了解非瓣膜性心房颤动(房颤)患者接受指南推荐的抗凝剂应用状况及影响因素。方法:依据2006年ACC/AHA/ESC房颤抗凝管理指南将患者按照年龄,脑卒中危险因素分成亚组,统计临床抗凝剂应用情况。结果:①在符合标准的220例房颤住院患者中,高危组患者占69.3%,所有房颤患者中仅20.9%的患者接受指南推荐的抗凝剂,其中高危组、中危组、低危组分别为15.7%、28.2%、36.3%。②对152例高危组房颤患者的非条件多因素logistic回归分析表明,年龄≥75岁(OR=7.12)、高血压(OR=12.44)、冠心病(OR=13.38)、临床医师的治疗决策(OR=7.11)、患者因素(OR=4.10)都是影响华法林使用的影响因素。结论:目前我国基层医院住院的非瓣膜病房颤患者多数未接受指南推荐的抗凝剂,尤其是房颤脑卒中高危患者。

Objective：To assess the current status of anticoagulation treatment and related factors in hospitalized patients with non-valvalar atrial fibrillation（AF）.Method：The 2006 ACC/AHA/ESC clinical guidelines were used to stratify patients into sub-groups according to age and stroke risk factors.Application of decoagulant was observed.Results：①A total of 220 cases with non-valvalar AF were enrolled.Among them,69.3% were in high risk group.Only 20.9% received appropriate antithrombotic therapy with 15.7%,28.2%,and 36.3% for high,moderate,and low-risk for stroke,respectively.②Among 152 patients in high risk group,a multi-variable logistic regression analysis showed that age≥75 years old （OR=7.12）,hypertension （OR=12.44）,coronary artery disease （OR=13.38）,treatment decision-making of physicians （OR=7.11）,and patients factors （OR=4.10） were associated with low rates of warfarin use.Conclusion：Most of these patients with non-valvalar AF,including high risk patients,did not receive appropriate antithrombotic therapy.