中危非瓣膜性心房颤动患者抗凝治疗策略

The strategy of anticoagulation therapy tomedium dangerous degree non-valvular atrial fibrillation

目的:针对指南推荐对于CHA2DS2-VASc评分为1分的中危非瓣膜性心房颤动患者抗凝治疗决策相对灵活性,分析评估目前CHA2DS2-VASc评分为1分的中危房颤患者抗凝治疗现状,探讨针对这一人群的抗凝治疗策略。方法:回顾性分析我院中危非瓣膜性心房颤动患者192例,依据患者意愿给予服用华法林、阿司匹林和不服药,将其分为华法林规范服药组、华法林不规范服药组、阿司匹林组和不服药组。观察与对比各组治疗后出血事件发生情况及随访1年后终点事件[短暂性脑缺血发作(TIA)、缺血性脑卒中、外周动脉栓塞]发生率。结果:192例CHA2DS2-VASc评分为1分的心房颤动患者中,服用华法林的例数少于服用阿司匹林与不服药的例数(P<0.05);华法林规范服药组出血事件发生率低于阿司匹林组和华法林不规范服药组(P<0.05);华法林规范服药组和阿司匹林组终点事件发生率显著低于华法林不规范服药组和不服药组(P<0.05)。结论:CHA2DS2-VASc评分法为1分的心房颤动患者虽然为中危人群,规范抗凝或抗血小板治疗是必要的。结合我国国情服用阿司匹林是必要的和值得推荐的选择。

Objective：Because anticoagulation therapy suggestion of guidelines to patients with non-valvular atrial fibrillation（CHA2DS2-VASc scoring=1）was flexibilitable.We discuss strategy of anticoagulation therapy in this area.Method：According to patients＇ willness,192 patients of our hospital taking warfarin、aspirin and no-medications were divided into standard taking warfarin、unstandard taking warfarin、aspirin and no-medications groups.The patients were analyzed retrospectively.This study tried to compare the terminal events（transient ischemic attack、ischemic stroke、peripheral-artery embolism）one year later of every anticoagulation therapy and bleeding risk rate of warfarin、aspirin and no-medications in 192 patients with non-valvular atrial fibrillation（CHA2DS2-VASc scoring=1）.Result：Of 192 patients with non-valvular atrial fibrillation（CHA2DS2-VASc scoring=1）the ratio of taking warfarin was less than aspirin and no-medications（P〈0.05）.The bleeding ratio of standard taking warfarin was less than aspirin and unstandard taking warfarin（P〈0.05）.The terminal events ratio of standard taking warfarin and aspirin was less than unstandard taking warfarin and no-medications（P〈0.05）.Conclusion：Though patients with non-valvular atrial fibrillation（CHA2DS2-VASc scoring=1）were medium dangerous degree,standard anticoagulation or antiplatelet therapy was necessary.In china taking aspirin was more necessary and recommendable choice than warfarin to patients with non-valvular atrial fibrillation（CHA2DS2-VASc scoring=1）on terminal events prevention.