嘉兴地区急性缺血性卒中合并心房颤动患者抗凝治疗现状分析

Current Status of Anticoagulant Therapy in Acute Ischemic Stroke Patients with Atrial Fibrillation in Jiaxing

目的调查嘉兴地区急性缺血性卒中合并心房颤动患者的抗凝治疗现状。方法回顾性分析2016年1月-2020年12月基于CT临床数据采集系统对卒中医疗质量改进的研究登记库-Ⅱ(computer analysing system to improve stroke management quality evaluation-Ⅱ,CASE-Ⅱ)中的嘉兴地区卒中中心登记的急性缺血性卒中合并心房颤动住院患者的信息。根据患者出院是否带有抗凝药物分为出院抗凝组与出院未抗凝组,比较两组患者的基本特征,采用logistic回归分析出院抗凝药物使用的影响因素;并进一步在既往诊断心房颤动且卒中高危(CHA2DS2-VASc≥2分)患者亚群中分析抗凝药物使用的影响因素。结果共纳入患者2005例,平均年龄77±8岁,男性979例(48.8%),NIHSS中位评分5(2~13)分。无抗血栓治疗禁忌证患者1817例,出院时带抗血栓药物比例为83.9%(1525/1817),其中抗凝药物比例为41.3%(750/1817)。年龄(OR 0.964,95%CI 0.952~0.976),基线NIHSS评分(OR 0.935,95%CI 0.920~0.951),住院时间(OR 1.045,95%CI 1.025~1.066),深静脉血栓(OR 2.797,95%CI 1.472~5.311),住院期间是否发生任意的颅内出血(OR 0.085,95%CI 0.038~0.188)、消化道出血(OR 0.503,95%CI 0.257~0.985)、肺炎(OR 0.646,95%CI 0.488~0.856)是急性缺血性卒中合并心房颤动患者出院接受抗凝治疗与否的独立影响因素。既往诊断心房颤动且卒中高危患者接受抗凝治疗比例仅为16.0%(153/954),低龄(OR 0.957,95%CI 0.938~0.975)、低收缩压(OR 0.985,95%CI 0.977~0.993)、卒中/TIA病史(OR 2.773,95%CI 1.954~3.936)是其接受抗凝治疗的独立保护因素。结论嘉兴地区急性缺血性卒中合并心房颤动患者的抗凝治疗率较低,低龄、低基线NIHSS评分、长住院时间、合并深静脉血栓的患者更多接受抗凝治疗,住院期间发生颅内出血、消化道出血和肺炎的患者更少接受抗凝治疗。

Objective To investigate the current status of anticoagulant therapy in acute ischemic stroke(AIS)patients with atrial fibrillation(AF)in Jiaxing.Methods This retrospective analysis enrolled the AIS inpatients with AF in Jiaxing between January 2016 and December 2020 from the Computer Analysing System to Improve Stroke Management Quality Evaluation-Ⅱ(CASE-Ⅱ)stroke registration database.The patients were divided into anticoagulation group and non-anticoagulation group according to whether they received anticoagulants or not at discharge.The baseline characteristics of the two groups were compared,and multivariate logistic regression analysis was used to determine the influencing factors for using anticoagulants at discharge.The influencing factors for using anticoagulants in the patients with AF and high stroke risk (CHA2DS2-VASc≥2 points) were analyzed.Results A total of 2005 patients were included, with a mean age of 77±8 years old and 979(48.8%) males. The median baseline NIHSS was 5 (2-13). 83.9% (1525/1817) of them receivedantithrombotic drugs at discharge, of which 41.3% (750/1817) received anticoagulants. Age (OR0.964, 95%CI 0.952-0.976), baseline NIHSS score (OR 0.935, 95%CI 0.920-0.951), the lengthof hospital stay (OR 1.045, 95%CI 1.025-1.066), deep vein thrombosis (OR 2.797, 95%CI 1.472-5.311), any intracranial hemorrhage during hospitalization (OR 0.085, 95%CI 0.038-0.188),gastrointestinal hemorrhage (OR 0.503, 95%CI 0.257-0.985) and pneumonia (OR 0.646, 95%CI0.488-0.856) were independent influencing factors for receiving anticoagulation at discharge. Only16.0% (153/954) of the AF patients with high stroke risk received anticoagulation, and younger(OR 0.957, 95%CI 0.938-0.975), lower systolic blood pressure (OR 0.985, 95%CI 0.977-0.993)and history of stroke/TIA (OR 2.773, 95%CI 1.954-3.936) were independent protective factors forreceiving anticoagulation in the AF patients with high stroke risk.Conclusions The anticoagulation rate of AIS patients with AF in Jiaxing was low. Yonger, lowerbaseline NIHSS score, longer length of hospital stay, and deep vein thrombosis were positiveinfluencing factors for anticoagulation, and any intracranial hemorrhage during hospitalization,gastrointestinal hemorrhage and pneumonia were negative influencing factors for anticoagulation.