NOACs在非瓣膜病心房颤动合并肾功能不全住院患者中的用药分析

Analysis of application of NOACs in inpatients with non-valvular atrial fibrillation complicated with renal insufficiency

目的探讨新型口服抗凝剂(Novel oral anticoagulants,NOACs)在非瓣膜病心房颤动(Nonvalvular atrial fibrillation,NVAF)合并肾功能不全住院患者中的临床应用情况及抗凝治疗特点。方法收集2018年全年我院NVAF合并肾功能不全住院期间使用NOACs患者的病历资料254份,并对适应证、用药情况、相关药物不良反应及合并用药等进行统计分析。采用血栓栓塞风险(CHA2 DS2-VASc评分)与抗凝出血危险评估(HAS-BLED评分),对所选患者进行脑卒中、出血风险评估。结果254例NVAF患者平均CHA2 DS2-VASc评分为(3.1±1.8)分,其中口服达比加群酯抗凝为148例、利伐沙班抗凝为106例;出现出血情况25例。结论NOACs在NVAF合并肾功能不全住院患者中应用时,需要结合年龄、体重指数、出血风险、肌酐清除率进行品种和剂量的调整,但住院期间的新型口服抗凝药物规范使用率偏低。

Objective To explore the clinical application of NOACs in inpatients with NVAF complicated with renal insufficiency and the characteristics of anticoagulation therapy.Methods Totally 254 medical records of NVAF patients with renal insufficiency using NOACs during the hospitalization in our hospital in 2018 were collected,and the indications,medications,adverse drug reactions and combined medications were analyzed statistically.The stroke and bleeding risk was assessed by CHA2 DS2-VASc scoring and the HAS-BLED scoring.Results The average CHA2 DS2-VASc score of 254 patients with NVAF was(3.1±1.8),of which 148 were anticoagulated with dabigatran etexilate,106 were anticoagulated with rivaroxaban,and 25 had bleeding.Conclusion The variety and dose need to be adjusted according to age,body mass index,bleeding risk and creatinine clearance rate of NVAF patients with renal insufficiency,but the rate of standard oral anticoagulant drug use during hospitalization is relatively low.