急性缺血性脑卒中合并非瓣膜性心房颤动患者出院时抗凝药使用分析

Analysis of anticoagulant use in patients with acute ischemic stroke and nonvalvular atrial fibrillation at discharge

目的调查急性缺血性脑卒中(AIS)合并非瓣膜性心房颤动(NVAF)患者出院时未处方口服抗凝药的影响因素。方法采用回顾性研究,提取2017年6月至2020年6月期间出院的合并NVAF的AIS患者的病例资料,根据出院医嘱记录,将患者分为处方抗凝药组和未处方抗凝药组,采用单因素分析和多因素Logistic回归分析,筛选影响患者出院时未处方抗凝药的相关因素。结果共278例患者纳入分析;出院时处方抗凝药组52例(18.71%),未处方抗凝药组226例(81.29%)。单因素分析显示两组患者年龄、住院天数、合并冠心病、入院前使用抗凝药物和左心房直径比较,差异有统计学意义(P<0.05)。多因素Logistic回归结果显示,年龄≥75岁是出院时未处方抗凝药的危险因素(OR=3.693,95%CI 1.541~8.851,P=0.003);住院天数≥9d(OR=0.224,95%CI 0.083~0.608,P=0.003)、左心房直径≥39mm(OR=0.322,95%CI0.164~0.632,P=0.001)是出院时处方抗凝药的保护因素。结论合并NVAF的AIS患者出院时处方口服抗凝药的比例较低,年龄≥75岁是出院时未处方抗凝药的危险因素,住院天数≥9d、左心房直径≥39mm是出院时处方抗凝药的保护因素。

Objective To investigate the influencing factors of without prescription oral anticoagulants in patients with acute ischemic stroke(AIS)complicated with nonvalvular atrial fibrillation(NVAF).Methods The case data of AIS patients with NVAF who were discharged from hospital from June 2017 to June 2020 were extracted retrospectively.The patients were divided into prescription anticoagulant group and non-prescription anticoagulant group according to the records of discharged doctor’s orders.Univariate analysis and multivariate Logistic regression analysis were used to screen the related factors affecting the patients without prescription anticoagulant at discharge.Results A total of 278 patients were included in the analysis;52 cases(18.71%)were in the prescription anticoagulant group,and 226 cases(81.29%)were in the non-prescription anticoagulant group.Univariate analysis showed that there were significant differences in age,length of stay,coronary heart disease,anticoagulant use before admission and left atrial diameter between the two groups(P<0.05).Multivariate logistic regression analysis showed that age≥75 years(OR=3.693,95%CI:1.541-8.851,P=0.003)was the risk factor of non-prescription anticoagulant at discharge,length of stay≥9 days(OR=0.224,95%CI:0.083-0.608,P=0.003)and left atrial diameter≥39 mm(OR=0.322,95%CI:0.164-0.632,P=0.001)were protective factors of prescription anticoagulant at discharge.Conclusion The proportion of patients with AIS complicated with NVAF who were prescribed oral anticoagulants at discharge was low.Age≥75 years old was the risk factor of non-prescription anticoagulants at discharge,while length of stay≥9 days and left atrial diameter≥39 mm were protective factors of prescribed anticoagulants at discharge.