房颤患者规范化抗凝治疗现状调研

Study of Standardized Anticoagulant Therapy in Patient with Atrial Fibrillation

目的:了解心房颤动患者规范化抗凝治疗现状,分析影响规范化抗凝治疗的因素,同时为进一步提出相应的对策打下基础。方法:查阅2010年1～12月份南京鼓楼医院心内科明确诊断患有非瓣膜性心房颤动的患者病历,采用CHADS2风险评分法对这些患者进行出血风险评估,根据ACC/AHA/ESC心房颤动治疗指南评价其规范化抗凝情况。结果:共入选患者200名,使用华法林进行抗凝治疗的仅39人(19.5%),其中仅有18人(46%)国际标准化比值(INR)达目标抗凝范围(INR:2.0～3.0);按照CHADS2评分将入组患者分组,其中高危患者143人中,进行华法林抗凝治疗的仅31人。结论:心房颤动患者进行规范抗凝治疗的比例很低(40%),其中高危患者中使用华法林进行规范治疗的比例尤甚(22%)。由此,应针对房颤患者规范化抗凝治疗率低的现状,进一步调查与了解发生这一现象的原因,从而采取有效的干预措施,提高房颤患者规范化抗凝治疗率。

Objective： To understand current the state of standardized anticoagulant therapy in patient with atrial fibrillation and analyze the factors that affect standard anticoagulant therapy,and at the same time,to make progress by the foundation of corresponding countermeasures.Methods：Diagnosed non-valvular atrial fibrillation patients were history inspected for a period of 12 months（January-December 2010） in Nanjing Drum Tower Hospital Cardiovascular Department,CHADS2 scheme method was used to stratify atrial fibrillation patient and assess their risk of bleeding,the standardized anticoagulant therapy conditions were evaluated according to ACC/AHA/ESC（American College of Cardiology/American Heart Association/ European Society of Cardiology） atrial fibrillation treatment guidelines.Results： A total of 200 patients were enrolled,39（19.5%） patient were on warfarin anticoagulant therapy,among which 18（46%） had international normalized ratio（INR） in therapeutic range（2.0~3.0）.According to the CHADS2 scheme,143 patients were divided into the high risk group,in which only 31 were on warfarin anticoagulant treatment.Conclusion： The percentage of standard anticoagulant treatment in patients with atrial fibrillation is very low（40%）,still more,the percentage of high risk patients using warfarin standard anticoagulant treatment was even low 22%.Further investigation and understanding of the causes of this phenomenon will help intervene effectively and improve the standard of anticoagulant therapy in patient with atrial fibrillation.