老年房颤患者华法林抗凝治疗不足现状及原因

Deficiency status and influencing factors of oral walfarin anticoagulation in elderly patients with atrial fibrillation

目的评估老年房颤患者口服华法林抗凝（oral walfarin anticoagulation,OAC）治疗不足的状况并对其影响因素进行分析。方法收集2012年8月至2014年8月在河北省博野县医院门急诊及住院确诊为老年房颤患者476例。使用华法林抗凝的患者为抗凝组,未使用华法林治疗的患者为非抗凝组。登记其一般情况、疾病特征、合并疾患及抗凝治疗等,对患者进行CHA_2DS_2-VASc风险评分,评估房颤患者的抗凝状况并对华法林使用的影响原因进行单因素及多因素分析。结果全部入选的476例老年房颤人群中,144例（30.25%）使用华法林抗凝。持续性房颤、糖尿病史、慢性心力衰竭史、缺血性卒中/一过性脑缺血发作史、CHA_2DS_2-VASc评分高者更多使用OAC治疗,合并冠心病的房颤患者由于更多用抗血小板药物而较少OAC治疗;患者依从性差、医生及患者担心出血为影响非华法林组抗凝药物使用的主要原因;在华法林组,使用药物剂量为0.65~3.50 mg/d,INR平均值为1.77±0.59;在多因素回归分析中,持续性房颤、慢性心力衰竭史、缺血性卒中/一过性脑缺血发作史及非冠心病是使用OAC治疗的预测因子。结论老年房颤患者中使用华法林抗凝治疗严重不足,且未能严格遵循血栓栓塞风险评估进行抗凝;持续性房颤、慢性心力衰竭史、缺血性卒中/一过性脑缺血发作史及非冠心病是使用OAC治疗的预测因子。

Objective To evaluate the deficiency status and analyze influencing factors of oral walfarin anticoagu- lation in elderly patients with atrial fibrillation. Methods 476 elderly patients with atrial fibrillation from August, 2012 to August, 2014 in emergency department of Boye county hospital of Hebei province and the cases diagnosed were divided into experimental group, according oral walfarin anticoagulation, oral warfarin anticoagula- tion for treatment, without oral warfarin therapy used as control group. The general situation, disease characteris- tics, combined disease and anticoagulant therapy were registered. The CHAzDS2-VASc risk score for patients was applied to evaluate the deficiency status and analyze influencing factors of oral walfarin antieoagulation. Results Among 476 cases of elderly patients with atrial fibrillation, 144 cases were treated with warfarin anticoagulation.Patients with persistent atrial fibrillation, diabetes history, history of chronic heart failure, history of ischemic stroke/transient ischemic attack,CHA2DS2-VASc score high used OAC therapy. Coronary heart disease patients with atrial fibrillation more used anti-platelet drugs and less OAC treatment. The main reasons for influence of anticoagulation in the control group were poor patient compliance, doctors and patients worried about bleeding. In the treatment group, the dose of the drug was 0.65-3.50 mg/d and INR was 1.77 ± 0.59. Multivariate regres- sion analysis showed that the predictors of OAC treatment were persistent atrial fibrillation, history of chronic heart failure, ischemic stroke/transient ischemic attack history and non coronary heart disease. Conclusion Oral Warfarin anticoagulation are serious shortage in elderly patients with atrial fibrillation and fail to strictly follow the thromboembolic risk assessment of anticoagulation. Persistent atrial fibrillation, history of chronic heart failure, ischemic stroke/transient ischemic attack history, and non coronary heart disease are predictive factors for the treatment of OAC.