持续性心房颤动患者116例抗栓治疗分析

Analysis on antithrombotic therapy for 116 cases of patients with persistent atrial fibrillation

目的评估2010年6月—-2011年12月我科持续性心房颤动住院患者抗栓治疗状况。方法查阅2010年6月—2011年12月我科116例持续性房颤住院患者临床资料,应用CHA_2DS_2-VASc评分系统评估患者卒中和血栓栓塞风险,统计患者抗栓治疗用药情况,同时应用HAS-BLED出血风险评估方案评估抗栓治疗的出血风险。结果 CHA_2DS_2-VASc积分1分者4例,均口服阿司匹林。积分≥2分者112例,口服阿司匹林54例(48.2%),口服华法林39例(34.8%),口服氯吡格雷+阿司匹林8例(7.1%),口服阿司匹林+华法林3例(2.7%),口服氯吡格雷2例(1.8%),未服抗栓药6例(5.4%)。其中口服华法林出院时INR<1.5者14例,INR在1.5~2.0者20例,INR在2.0~3.0者8例。CHA_2DS_2-VASc积分≥2分,且HAS-BLED积分≥3分共45例(40.2%)。结论我科持续性房颤住院患者的抗栓治疗与指南要求尚有差距,口服抗凝治疗明显不足。血栓栓塞高发人群通常也是出血高危人群,因此抗栓治疗更应规范并谨慎监测。

Objective To analyze the treatment status of 116 cases of patients with persistent atrial fibrillation who underwent an- tithrombotie therapy in this department from June 2010 to December 2011. Methods The clinical data of 116 eases of patients with persistent atrial fibrillation who underwer/t antithrombotic therapy in this department from June 2010 to December 2011 was ret- rospectively analyzed. The CHA2DS2-VASc scoring system was used to assess the risk of stroke and thromboembolism of these pa- tients, then a statistical analysis was made ：on their antithrombotic treatment status, while applying HAS-BLED bleeding risk assess- ment program for the evaluation on bl^eedir^g risk of antithrombotic therapy. Results 4 cases had 1 point for CHA2DS2-VASc sco- ring and were orally administrated with aspirin. For 112 cases of patients with CHA2DS2-VASc score〉~ 2 points, 54 cases were orally administrated with aspirin （48.2%） ：,~ 39 cases were＂ orally administrated with warfarin （34.8%） , 8 cases were orally ad- ministrated with clopidogrel ＋ aspirin （7.1%） , 3 cases were orally administrated with aspirin ＋ warfarin （2.7%） , 2 cases were orally administrated with clopidogrel （ 1.8% ） , 6 cases didn! t receive any antithrombotic drug （5.4%）. For patients administra- ted with warfarin, 14 cases had INR 〈 1.5 at discharge, 20 cases had INR within 1.5 - 2.0, 8 cases had INR within 2.0 - 3.0. A total of 45 cases had CHA2DS2-VASe score ~〉 2 points and HAS-BLED score ~〉3 points （40.2%）. Conclusion The treat- ment status of patients with persistent atrial fibrillation who undergo anfithrombotic therapy in this department still can＇ t perfectly meet the requirements of guidance, the oral anticoagulation therapy is clearly insufficient. The patients with high risk of thromboem- bolism are usually at high risk of bleeding, so the antithrombotic therapy should be more standardized and carefully monitored.