乡村老年非瓣膜病房颤患者抗凝治疗状况研究

Study on the Status of Anticoagulation Therapy in Rural Elderly Patients with Non-valvular Atrial Fibrillation

目的通过调查乡村老年非瓣膜病房颤(NVAF)患者的抗凝治疗现状,对比分析不同抗栓方案的临床疗效。方法入选佛山市顺德区乐从镇≥65岁的NVAF患者533例,分为对照组(n=95)和观察组(n=438)。对照组接受华法林规范抗凝(TTR≥65%)治疗,观察组中91例接受华法林不规范抗凝(TTR<65%)治疗、347例患者口服阿司匹林(100mg/d)或氯吡格雷(75mg/d)。回顾性分析患者血栓栓塞事件(缺血性脑卒中、短暂性脑缺血发作、体循环血栓栓塞)及出血事件的发生率。结果口服华法林的患者中51.1%的TTR≥65%,533例NVAF患者中65.1%的接受抗血小板治疗。对照组血栓栓塞事件发生率6.32%低于TTP<65%者15.38%(P<0.05),也低于口服抗血小板药物者14.99%(P<0.05)。与口服抗血小板药物者比较,对照组大出血及总出血事件的发生率未见明显增加(P>0.05)。多变量Cox回归分析显示,女性、年龄≥75岁、高血压、短暂性脑缺血发作/缺血性脑卒中病史、慢性心力衰竭、冠心病是血栓栓塞事件独立的危险因素;年龄≥75岁、肾功能异常、贫血、既往出血病史、口服非甾体类消炎药是出血事件独立的危险因素。结论对于老年NVAF患者,规范化华法林抗凝治疗可以显著降低血栓栓塞事件发生率,而且是安全的。但乡村老年NVAF患者规范化抗凝情况并不理想。

Objective By investigating the current status of anticoagulation therapies in rural elderly patients with non-valvular atrial fibrillation(NVAF),the clinical efficacy of different antithrombotic regimens was compared and analyzed.Methods A total of 533 NVAF patients aged 65 years and above in Lecong Town,Shunde District,Foshan City,were selected and divided into control group(n=95)and observation group(n=438).The control group received standard anticoagulation with Warfarin(TTR≥65%),while 91 patients in the observation group received irregular anticoagulation with Warfarin(TTR<65%),and 347 patients received oral Aspirin(100 mg/d)or Clopidogrel(75mg/d).The incidence of thromboembolic events(ischemic stroke,transient ischemic attack,systemic thromboembolism)and bleeding events were retrospectively analyzed.Results 51.1%of patients receiving oral warfarin had a TTR≥65%,and 65.1%of the 533 patients with NVAF received antiplatelet therapy.The incidence of thromboembolic events in the control group was 6.32%lower than that in the patients with TTR<65%was 15.38%(P<0.05),or oral antiplatelet drug was 14.99%(P<0.05).Compared with oral antiplatelet drugs,the incidence of major bleeding and total bleeding events in the control group did not increase significantly(P>0.05).Multivariate Cox regression analysis showed that female gender,age≥75 years,hypertension,history of transient ischemic attack/ischemic stroke,chronic heart failure,and coronary heart disease are independent risk factors for thromboembolic events,while age≥75 years,abnormal renal function,anemia,previous history of bleeding,and oral non-steroidal anti-inflammatory drugs are independent risk factors for bleeding events.Conclusion In elderly patients with NVAF,standardized anticoagulation with warfarin can significantly reduce the incidence of thromboembolic events and is safe.However,the situation of the anticoagulation therapy in rural elderly patients with NVAF is suboptimal.