非瓣膜病房颤患者华法林抗凝治疗的现状

Analysis of anticoagulant therapy in the patients with nonvalvular atrial fibrillation

目的了解非瓣膜病心房颤动(房颤)患者口服华法林抗凝治疗状况及其影响因素。方法收集2012年6月至2014年6月在我科住院的非瓣膜病房颤患者一般情况、疾病特征、合并疾病及抗凝治疗等,并对患者进行CHA_2DS_2-VAS_C风险评分,评估房颤患者的抗凝治疗现状,并对影响华法林使用的因素进行多因素分析。结果在入选的499例房颤人群中,有77例(15.4%)接受华法林治疗,其中慢性心力衰竭史、永久性房颤、缺血性卒中/一过性脑缺血发作史,CHA_2DS_2-VAS_C风险评分高者更多使用华法林治疗,合并冠心病的房颤患者更多选用抗血小板药物治疗。多因素回归分析显示,年龄、冠心病、心力衰竭病史都是影响华法林使用的因素。结论非瓣膜病房颤患者使用华法林抗凝治疗严重不足,未能严格按照CHA_2DS_2-VAS_C风险评分进行正规抗凝。

Objective To evaluate the present status and influencing factors of the usage of oral anticoagulation（OAC）in Chinese patients with non-valvular atrial fibrillation.Methods The clinical characteristics and anticoagulation treatment of the patients with non-valvular atrial fibrillation in our hospital from June 2012 to June 2014 were analyzed.The factors affecting the oral walfatin use were evaluated by multivariable regression analysis.Results OAC therapy with walfarin was applied in only 77（15.4%） patients with non-valvular atrial fibrillation.The patients with persistent atrial fibrillation,chronic heart failure,history of ischemic stroke/TIA or with higher CHA_2DS_2-VAS_c score were more likely to receive walfatin.Multivariable regression analysis showed that age,coronary disease and history of heart failure were the factors of oral anticoagulation（OAC）.Conclusions The usage ratio of OAC is extremely low in patients with nonvalvular atrial fibrillation.It is important to improve OAC use in these patients.