单中心非瓣膜病心房颤动患者抗凝治疗状况分析

A single center analysis of anticoagulant therapy in patients with nonvalvular atrial fibrillation

目的探讨非瓣膜病心房颤动患者口服抗凝药治疗的现状及影响因素,以更好地指导临床抗凝治疗。方法选取2017年8月至2018年4月在解放军福州总医院心血管内科诊断为心房颤动的患者,收集临床基础资料和抗凝治疗情况,采用CHA_2DS_2-VASc评分进行卒中风险评估,评价患者的抗凝治疗方案。结果共529例患者入选本研究。395例CHA_2DS_2-VASc评分≥2的患者中,156例(39.5%)接受抗凝治疗(单药或与抗血小板药物联合),137例(34.7%)接受抗血小板治疗,102例(25.8%)未行抗栓治疗。81例CHA_2DS_2-VASc评分为1的患者中,21例(25.9%)接受抗凝治疗(单药或与抗血小板药物联合),35例(43.2%)接受抗血小板治疗,25例(30.9%)未行抗栓治疗。53例CHA_2DS_2-VASc评分为0的患者中,12例(28.3%)接受了抗凝治疗。入组的529例患者中,277例(52.4%)抗栓治疗方案合理,13例(2.5%)治疗过度,137例(25.9%)治疗不足,102例(19.3%)未治疗。189例接受抗凝治疗的患者中,128例(67.7%)服用华法林治疗,61例(32.3%)服用新型口服抗凝药(46例服用达比加群酯,15例服用利伐沙班)。结论本研究非瓣膜病心房颤动患者中74.7%为卒中高危患者,其中61.5%的患者治疗过度、治疗不足或未进行抗栓治疗,应规范抗凝治疗,减少卒中风险。

Objective To analyze the application of anticoagulant therapy and the related factor in the patients with nonvalvular atrial fibrillation (NVAF) so as to better guide clinical anticoagulant therapy. Method The clinical data including baseline clinical characteristics, complications, anticoagulant therapy and risk evaluation of thromboembolism (based on CHA2DS2-VASc score) in patients with NVAF from August 2017 to April 2018 were analyzed. Result A total of 529 patients were enrolled. 395 patients had a CHA2DS2-VASc score≥2, 156(39.5%) patients received anticoagulant therapy (anticoagulant alone or in combination with antiplatelet agents), 137(34.7%) patients were treated with antiplatelet, 102(25.8%) patients did not receive anti-thrombotic treatment. 81 patients had a CHA2DS2-VASc score=1, 21(25.9%) patients received anticoagulant therapy, 35(43.2%) patients were treated with antiplatelet, 25(30.9%) patients did not receive anti-thrombotic treatment. 53 patients had a CHA2DS2-VASc score=0, 12(28.3%)patients received anticoagulant therapy. Of the 529 patients, 277(52.4%) patients were treated in line with the curent guideline recommendation, 13(2.5%) patients were over-treated, 137(25.9%)patients were treated improperly, 102(19.3%) patients received no anti-thrombotic. 189 patients received anticoagulant therapy, 128(67.7%) patients with warfarin and 61(32.7%) patients with novel oral anticoagulant (NOAC). Conclusion 74.7% NVAF patients were at high risk of thromboembolism. 61.5% of them were either over-treated, inadequately treated or un-treated. It is necessary to improve anti-thrombotic therapy status in patients with NVAF.