高危老年非瓣膜性心房颤动患者抗凝治疗调查

Investigation of anticoagulation therapy for elderly patients with high risk of nonvalvular atrial fibrillation

目的调查高危老年非瓣膜性心房颤动(NVAF)患者的抗凝治疗情况。方法回顾性调查2008年1月至2010年1月住院治疗且CHADS2评分2分以上的198例NVAF患者,分析华法林的使用率和效果、未使用华法林原因,并探讨相应的对策。结果 (1)按指南须口服华法林者中,华法林实际应用仅51例(25.8%),服用阿司匹林107例,未抗栓40例。与无抗栓组、阿司匹林组对比,华法林组缺血性脑卒中发生率明显减少(P<0.05);与无抗栓组对比,阿司匹林组缺血性脑卒中发生率也减少(P<0.05)。各组间出血、全因死亡情况均无统计学差异。(2)高龄、并存疾病多、用药复杂、肝肾功能障碍、认识不足及过分担心出血并发症是未使用华法林的主要原因。结论目前必须加强高危老年NVAF患者长期抗凝治疗的管理。

Objective To investigate the current situation of antithrombotic treatment in the patients with high risk of nonvalvular atrial fibrillation（NVAF）.Methods Retrospective surveys of 198 inpatients with primary diagnosis of NVAF enrolled with the CHADS2 score of 2 or more were conducted from Jan.2008 to Jan.2010.The usage rates and effects of warfarin,the reasons of warfarin unused were analyzed and the corresponding countermeasures were explored.Results（1）Among all the patients who need warfarin therapy according to the guidelines,51 cases（25.8%）took warfarin,107 cases took aspirin and 40 cases didn′t take any anti-thrombotic drug.Compared with the non-antithrombotic drug group and the aspirin group,the risk of ischemic stroke in the warfarin group was significantly lower.Compared with the non-antithrombotic drug group,the aspirin group also reduced the risk of ischemic stroke.There was no significant difference of bleeding and the all-cause death rate among the three groups.（2）Old age,with many other diseases,complicated drugs,kidney and liver dysfunction,understanding shortage and too much worry about bleeding complications were the main reasons of warfarin unused.Conclusions The management for long-term anticoagulant therapy of the patients with high risk of NVAF should be strengthened.