非瓣膜性房颤患者抗血栓药应用情况分析

Application of Antithrombotic Drugs in Patients with Nonvalvular Atrial Fibrillation

目的分析平顶山市第一人民医院非瓣膜性房颤(NVAF)患者抗血栓药应用情况,为临床合理进行抗凝治疗提供依据。方法回顾性分析2019年1—12月入住平顶山市第一人民医院心血管内科的211例NVAF患者的临床资料,结合卒中风险评分(CHADS 2评分)和出血风险评分(HAS-BLED评分)对抗血栓药的使用情况进行分析。结果211例NVAF患者中,接受华法林或抗血小板药物治疗的共198例(93.84%)。CHADS 2≥1分的患者有204例(96.68%),其中11.27%(23/204)接受华法林抗凝,82.35%(168/204)接受抗血小板治疗。不同CHADS 2评分患者抗血栓用药情况差异有统计学意义(P<0.05)。HAS-BLED≥3分的患者有83例(39.34%),其中3.61%(3/83)接受华法林治疗,96.39%(80/83)接受抗血小板治疗。HAS-BLED评分0~2分与≥3分患者抗血栓用药方案相比,差异有统计学意义(P<0.05)。23例接受华法林治疗的患者国际标准化比值(INR)总监测率为100%,INR达标率为21.74%(5/23),INR在治疗目标范围内的时间(TTR)>60%的患者占4.35%(1/23)。以204例CHADS 2评分≥1分的患者为研究对象进行单因素分析,结果显示卒中或短暂性脑缺血发作(TIA)史、HAS-BLED评分(≥3分)与NVAF患者抗血栓用药情况有关(P<0.05)。结论平顶山市第一人民医院NVAF患者华法林使用率和INR达标率低,抗凝治疗稳定性差,存在抗凝严重不足的问题。

Objective To analyze the application of antithrombotic drugs in patients with nonvalvular atrial fibrillation(NVAF)in the First People’s Hospital of Pingdingshan,and provide a basis for reasonable anticoagulation therapy.Methods The clinical data of 211 patients with NVAF who were admitted to the Department of Cardiovascular Medicine,the First People’s Hospital of Pingdingshan from January to December 2019 were retrospectively analyzed.The use of antithrombotic drugs was analyzed combined the stroke risk score(CHADS 2)and bleeding risk score(HAS-BLED).Results Among 211 patients with NVAF,198(93.84%)received warfarin or antiplatelet drugs.There were 204 patients(96.68%)with CHADS 2≥1 points,of which 11.27%(23/204)received warfarin and 82.35%(168/204)received antiplatelet drugs.There was a statistical difference in the antithrombotic use among patients with different CHADS 2 scores(P<0.05).There were 83 patients(39.34%)with HAS-BLED≥3 points,of which 3.61%(3/83)received warfarin and 96.39%(80/83)received antiplatelet therapy.There was a statistical difference in the antithrombotic medication regimen between patients with HAS-BLED score of 0 to 2 points and≥3 points(P<0.05).Among the 23 patients who received warfarin,the total monitoring rate of the International Normalized Ratio(INR)was 100%,the INR control rate was 21.74%(5/23),and the patients whose INR was in the treatment target range(TTR)more than 60%of the time accounted for 4.35%(1/23).Univariate analysis of 204 patients with CHADS 2≥1 points was performed.The results showed that history of stroke or transient ischemic attack(TIA)and HAS-BLED score(≥3 points)were related to the use of antithrombotic drugs(P<0.05).Conclusion In the First People’s Hospital of Pingdingshan,the use rate of warfarin and INR control rate are low in NVAF patients,the stability of anticoagulation therapy is poor,and the anticoagulation is seriously insufficient.