肥厚型心肌病合并房颤老年住院患者抗凝情况分析

Analysis of anticoagulation of atrial fibrillation in senior in-patients with hypertrophic cardiomyopathy

目的调查老年肥厚型心肌病合并心房颤动(房颤)住院患者的抗凝情况。方法回顾分析阜外医院2015年1月1日至2017年12月31日期间内科入出院≥60岁患者,记录患者年龄、性别、身体质量指数(BMI)、房颤类型、CHA_2DS_2-VASc评分、HAS-BLED评分、左房前后径、出院前估测肾小球滤过率(eGFR)水平、合用抗血小板用药等临床信息及出院抗凝情况,根据是否抗凝及使用华法林或新型口服抗凝药(New oral anticoagulants,NOACs)进行分组,进行单因素及多因素分析。结果共入选134例患者,抗凝组85人(63.4%),非抗凝组49人(36.6%)。单因素分析中,非抗凝组年龄偏大[69(65,74)岁比65(62,69)岁,P=0.002]、女性患者偏多(55.1%比36.47%,P=0.036)、BMI偏低[23.53(21.48,25.39)kg/m^2比25.40(23.43,28.34)kg/m^2,P=0.0124]、持续性房颤占比偏低(24.49%比61.1 8%,P<0.001)、合并既往出血史患者偏多(18.37%比7.06%,P=0.046)、HAS-BLED评分偏高[2(1,3)比1(0,2),P=0.009]、左房前后径偏低[43(39,48)mm比47(42,52)mm,P=0.007]、合用抗血小板患者数目偏多[27(55.10%)比10(11.76%),P<0.001]。多因素分析发现低BMI(OR=3.411,95%CI 1.836-6.337)、阵发性房颤(OR=10.119,95%CI 3.736-27.412)、合用抗血小板药物(OR=15.86,95%CI 5.26-47.92)为不抗凝相关因素;抗凝组中,华法林与NOACs两组患者临床基线无明显差异,NOACs的应用逐年增多(OR=3.3 14,95%CI 1.634-6.721)。结论本中心近三年老年肥厚型心肌病合并房颤患者抗凝率为63.4%,新型口服抗凝药在此类患者的应用逐年增多。

Objective To investigate the single-center anticoagulation status of patients with atrial fibrillation (AF) in senior hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) in-patients. Methods Senior patients (not less thanover 60 years old) with HCM and complicated with AF who, discharged from January 1st, 2015 to December 31st, 2017 were retrospectively analyzenrolled. Their clinical informationdata, including such as age, sex, body-mass index (BMI), classification of AF, CHA2DS2-VASC score, HAS-BLED score, left atrial diameter (anterior to posterior), estimated glomerular filtration rate (eGFR), combined and antiplatelet medication, were collectrecorded. All patientsThey were divided into two groups according to whether anticoagulated orion status not. PThe anticoagulated patients receiving anticoagulation therapy were further divided by whetheraccording to the use of warfarin or new oral anticoagulants (NOACs) were administered. Univariate and multivariate analyses were run. Results Among 134 patients were enrolled, 85 of 134 (63.4%) patients were divided into the anticoagulation group and the rest 49 (36.6%) into the non-anticoagulation group. Univariate analysis revealed showed the non-anticoagulation group had more older patients [69 (65, 74) vs. 65 (62, 69), P=0.002], more female patients (55.1% vs. 36.47%, P=0.036), more patients with higher HAS-BLED scores [2(1, 3) vs. 1(0, 2), P=0.008] or previous bleeding history (1&37% vs. 7.06%, P=0.0455), and more patients combined with antiplatelet drugs [27(55.10%) vs. 10(11.76%), P <0.001], while BMI [23.53 (21.48, 25.39) kg/m2 than 25.40 (23.43, 28.34) kg/m^2, P=0.012], the proportion of persistent atrial fibrillation (24.49% vs. 61.18%, P<0.001), left atrial diameter (anterior to posterior)[43 (39, 48) mm vs. 47 (42, 52) mm, P=0.007] were lower in this group. Multivariate analysis found lower BMI (OR=3.411, 95% CI 1.836-6.337), paroxysmal type of atrial fibrillation (OR=10.119, 95% CI 3.736-27.412) and combined with antiplatelet drugs 15.860, 95% CI 5.26-47.92) were related to non-anticoagulation. Among anticoagulated patients, there was no significant difference in clinical information between the warfarin and NOACs group. The administration of NOACs increased year by year (OR=3.314, 95% CI 1.634-6.721). Conclusions The anticoagulant rate of atrial fibrillation in elderly patients with hypertrophic cardiomyopathy in our hospital is 63.4% in recent three years. NOACs are used increasingly year by year.