规范抗凝对心房颤动住院患者预后的影响

Impact of preadmission anticoagulation adherent to guidelines on prognosis of the patients with atrial fibrillation

目的:探讨既往规范抗凝与未规范抗凝治疗的心房颤动(房颤)患者住院期间发生全因死亡、卒中和出血的风险。方法:回顾性分析我院2008年9月至2018年12月的房颤住院患者5526例,依据住院记录、病程记录和出院诊断确认结局,包括任何出血、大出血、小出血、胃出血、卒中和死亡。进行单变量和多变量Logistic回归分析探索住院期间终点事件的发生风险。结果:1480例(22.78%)患者采用规范抗凝治疗,其住院期间的卒中发生风险低于未规范抗凝治疗的患者[优势比(odds ratio,OR)=0.68,95%置信区间(confidence interval,CI):0.50~0.92,P=0.01]。但是发生任何出血、大出血、小出血、胃出血和全因死亡的风险与未规范抗凝的患者相似。结论:规范抗凝降低了卒中的风险,且不会增加任何出血、大出血、小出血、胃出血和全因死亡的风险。

Objective To explore the risk of all-cause death,stroke,and bleeding in the atrial fibrillation(AF)patients with or without recommended anticoagulation preadmitting to hospital.Methods A total of 5526 hospitalized AF patients in our hospital from September 2008 to December 2018 were enrolled and their information were analyzed retrospectively.The outcomes were confirmed according to hospitalization records,course records and discharge diagnosis,including all bleeding events,major bleeding,minor bleeding,gastric bleeding,stroke and death.Univariate and multivariate Logistic regression analysis was performed to explore the risk of end events during hospitalization.Results The patients with recommended anticoagulation(1480,22.78%)had lower risk of stroke[odds ratio(OR)=0.68,95%confidence interval(CI):0.50-0.92,P=0.01].They had similar risk in all bleeding events,major bleeding,minor bleeding,gastric bleeding and allcause death compared to those without recommended anticoagulation.Conclusions Recommended anticoagulation reduced the risk of all-cause death and stroke,but did not increase the risk of all bleeding events,major bleeding,minor bleeding,gastric bleeding and all-cause death.