基于多中心的非瓣膜性心房颤动患者抗凝治疗现状及影响因素分析

Current status and influencing factors of anticoagulant therapy in patients with non-valvular atrial fibrillation:multi-center study

目的:了解目前非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者的抗凝治疗现状,并分析其影响因素。方法:选择2017年1月1日至2017年9月30日在苏州、无锡地区4所医院住院及门诊的NVAF患者,分析其一般资料、临床特征及抗凝药物的治疗情况。采用CHA2DS2-VASc评分评估NVAF患者的卒中风险;采用HAS-BLED评分评估抗凝出血风险。结果:共纳入NVAF患者453例,卒中风险高危(CHA2DS2-VASc评分≥2分)者365例(80.6%)。其中,19例(5.2%)服用新型口服抗凝药治疗,87例(23.8%)服用华法林治疗,119例(32.6%)抗血小板药物治疗,140例(38.4%)未行抗凝治疗。年龄、心房颤动(AF)症状严重程度是影响NVAF卒中风险高危患者是否进行抗凝治疗的因素;60岁以上、有轻中度AF症状者接受抗凝治疗率较高(P<0.05)。结论:目前NVAF患者抗凝治疗率仍很低,须进行干预,尤其应对60岁以下及无症状的AF患者进行抗凝知识宣教。

Objective:To explore the current status and influencing factors of anticoagulant therapy in patients with non-valvular atrial fibrillation(NVAF).Methods:The eligible NVAF patients recruited from four hospitals in Suzhou and Wuxi between January 2017 and September 2017.The basic characteristics,clinic data,and anticoagulation treatments of enrolled patients were analyzed.CHA2DS2-VASc score was used to assess the risk of thromboembolism and HAS-BLED score was used to assess the risk of bleeding in NVAF patients.Results:A total of 453 patients were enrolled,365 cases(80.6%)of whom was with CHA2DS2-VASc score≥2.Among them,19(5.2%)were treated with new oral anticoagulants,87(23.8%)with warfarin,119(32.6%)with antiplatelet drugs,and 140(38.4%)without anticoagulant treatment.Age and degree of AF symptoms were the factors that affect whether NVAF patients with high risk of stroke should be treated with anticoagulation or not.Those over 60 years old or with mild and moderate AF symptoms had a higher rate of anticoagulation treatment.Conclusions:The rate of anticoagulant therapy is still low and measures should be taken to improve this condition,especially for NVAF patients under 60 years of age and asymptomatic patients.