成都西部地区老年非瓣膜病房颤患者抗凝的治疗现状

Analysis on Anticoagulation Therapy in Elderly Patients with non-valvular Atrial Fibrillation in the West Area of Chengdu

目的了解成都西部地区老年非瓣膜病房颤患者血栓栓塞风险及抗凝治疗现状。方法回顾性分析2015年11月至2017年11月在成都市第五人民医院住院的老年非瓣膜病房颤患者573例,依据CHADS2评分评估血栓栓塞风险,HAS-BLED评分评估出血风险,并比较不同栓塞危险分层的抗凝治疗现状。结果纳入65岁及以上非瓣膜病性房颤患者573例,平均年龄(78.30±9.64)岁,其中年龄≥80岁271例(47.3%)。573例入选患者CHADS2评分≥2分者492例(85.9%),其中年龄≥80岁患者血栓栓塞风险比例明显高于80岁以下患者。573例患者中,共291例(50.8%)接受单一抗血小板治疗,接受单一华法林抗凝治疗者88例(15.3%),接受新型口服抗凝药物者仅2例(0.3%),未接受抗栓治疗者135例(23.7%)。其中CHADS2评分≥2分的492例血栓栓塞高危患者中,仅86例患者选择华法林或新型口服抗凝药物进行抗凝治疗,262例患者单用阿司匹林或氯吡格雷抗血小板治疗,103例患者未进行抗栓治疗。结论成都西部地区老年非瓣膜病房颤患者大多属于血栓栓塞高风险人群,以80岁以上人群更为突出,但接受华法林或新型口服抗凝药进行抗凝治疗比例偏低。

Objective To investigate the risk of thromboembolism and the current status of antithrombotic treatment in elderly patients with non-valvular atrial fibrillation in the west area of Chengdu. Methods 573 elderly patients with non-valvular atrial fibrillation hospitalized in our hospital from November 2015 to November 2017 were analyzed retrospectively. Risk evaluation of thromboembolism was based on CHADS2 score and risk evaluation of hemorrhage was based on HAS-BLED score.Moreover,comparisons of anticoagulant therapy in different risk stratification of thromboembolism were made. Results 573 patients with non-valvular atrial fibrillation aged 65 and above were included. The mean age was 78.30±9.64 years old, of which 271(47.3%) patients were 80 years old or above. Among the 573 patients, thrombsis risk score CHADS2 score in 492 cases (85.9%) was≥2,and the risk of thromboembolism was higher in patients aged 80 or above than those below 80 years old. Among the 573 patients,291 patients(50.8%)received single antiplatelet therapy,88 patients(15.3%) received single warfarin anticoagulant therapy,2 patients(0.3%) received new oral anticoagulants and 135 cases(23.7%)received no antithrombotic therapy. Among patients with CHADS2 score ≥2, only 86 patients received warfarin or new oral anticoagulants for anticoagulant therapy, 262 patients were treated with aspirin or clopidogrel, and 103 patients received no antithrombotic therapy. Conclusion The elderly patients with non-valvular atrial fibrillation in the west area of Chengdu are mostly at high risk of thromboembolism,especially in the population over 80 years old. The percentage of anti-thrombosis therapy with warfarin or new oral anticoagulants is low.