影响老年非瓣膜性房颤患者抗凝决策的因素分析

Influencing factors on anticoagulation decision in elderly patients with nonvalvular atrial fibrillation

目的分析临床治疗中老年心房颤动(简称房颤)患者抗凝决策制订的影响因素及与指南建议的差异。方法老年房颤患者中,按照是否给予抗凝治疗,分为抗凝组和未抗凝组。分析抗凝治疗者与未抗凝治疗者的临床资料,包括一般情况、房颤分类、出血、栓塞事件、脏器功能、合并用药情况等方面的差异。结果研究共纳入老年房颤患者176例,年龄中位数90.0岁,卒中风险较高者(CHA_(2)DS_(2)-VASc评分≥2分)占97.7%。出血风险较高者(HAS-BLED评分≥2分)占75.9%,22.2%的患者口服抗凝药治疗。统计分析抗凝组与未抗凝组数据,显示高龄、低体重、生活自理能力不足、贫血状态、非持续性房颤、抗凝出血风险评分高等因素使得临床决策更倾向于选择不抗凝。结论临床工作中,未被指南列为房颤抗凝治疗禁忌证的因素(如高出血风险评分、低体重、具有衰弱相关症状及多病共存、多重用药等),常常成为医生不处方或终止抗凝治疗的原因,临床工作实际情况与指南建议仍有差距。

Objective To analyze the influencing factors on anticoagulation decision-making in elderly patients with atrial fibrillation(AF).Method All AF patients were divided into anticoagulation group and non-anticoagulation group.The characteristics of general information,classification of atrial fibrillation,factors that may influence anticoagulant decision-making and polypharmacy between two groups were retrospectively analyzed.Result A total of 176 AF patients were included in the study,with a median age of 90 years old.97.70%of patients were at high risk of stroke by evaluation of CHA_(2)DS_(2)-VASC score,while 75.90%of the patients were at high bleeding risk by evaluation of HAS-BLED score.22.2%of the patients were treated with oral anticoagulants.Patients with advanced age,low body mass index(BMI),poor activities of daily living(ADL),anemia,non-persistent AF,and high bleeding risk score were likely to refuse anticoagulant therapy.Conclusion In clinical practice,factors that are not listed as contraindications for AF anticoagulation,such as high bleeding risk,low BMI,frailty symptoms and polypharmacy,are often the reasons for non-anticoagulation.There is gap between actual clinical practice and guideline recommendations.