摘要
目的:心房颤动(AF)患者中用于脑卒中预防的华法林普遍存在用量不足的问题,反映了临床实践中的一个主要问题。本研究旨在确定适合的AF患者中接受华法林治疗的相关因素。方法与结果:研究对象为2002年斯德哥尔摩南方综合医院的瑞典AF患者(n=2796)。试验中的医疗记录资料经严格核查,并以瑞典国家医院出院登记库的数据补充。
Aims: Underuse of warfarin for stroke prophylaxis in atrial fibrillation (AF) is extensive and represents a major problem in clinical practice. To identify factors associated with warfarin treatment in eligible AF patients. Methods and results: The study population consisted of all Swedish resi-dent AF patients at the Stockholm South General Hospital during 2002(n=2796). Medical records were examined and complemented by data from the Swedish National Hospital Discharge Register. Sixty-eight percent of the patients(1898/2796) had indications, and no apparent contraindications for warfarin treatment. Of these 54%(1029/1898) got warfarin. Factors favouring warfarin treatment after adjustment for other factors were history of ischaemic stroke, an implanted pacemaker, treatment in a cardiology rather than internal medicine ward and valvular defect. Factors associated with a reduced likelihood of warfarin treatment were paroxysmal type of AF and age >80 years. Important risk factors for stroke in AF like heart failure, hypertension, and diabetes did not increase the chances of warfarin treatment. Conclusion: Risk stratification using known risk factors of stroke seems to affect warfarin treatment only to a minor degree in clinical practice. Undertreatment was particularly common in patients with paroxysmal AF and in patients aged >80 years and calls for improved clinical routines in accordance with international guidelines.
