急性脑梗死伴房颤患者抗凝治疗现状及影响因素分析

Status and influencing factors of anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation

目的调查某三甲医院急性脑梗死伴房颤患者抗凝治疗现状及影响因素。方法采取回顾性病例研究方法,抽取2019年出院、第一诊断为急性脑梗死或短暂性脑缺血发作,且诊断为非瓣膜性房颤的患者,记录出院时抗栓药物并收集相关的临床资料。采用SPSS 23.0统计软件进行单因素分析和多因素Logistic回归分析。结果符合条件的病例170例,平均年龄74(51~95)岁;男92例;CHA2DS2-VASc评分均≥3分;81例HAS-BLED评分≥3分。98例(57.65%)患者出院时接受抗凝治疗。多因素Logistic回归分析显示,入院前使用抗栓药物(OR=2.497,P=0.039)和会诊建议抗凝(OR=19.842,P<0.001)有助于患者接受抗凝治疗;而出血(OR=0.331,P=0.029)和患方拒绝抗凝(OR=0.006,P<0.001)不利于患者接受抗凝治疗。结论抗凝治疗存在不足,提高会诊医生的抗凝意识、提高患方对抗凝治疗的理性认识和依从性对改善抗凝不足现状具有积极意义。

Objective To investigate the current status and influencing factors of anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation.Methods A retrospective case study was conducted in patients who were discharged in 2019,with the first diagnosis of acute ischemic stroke or transient ischemic attack,accompanied by nonvalvular atrial fibrillation.The antithrombotic drugs on discharge were recorded,and the related clinical data was collected.SPSS 23.0 software was used for univariate statistical analysis and multivariate Logistic regression analysis.Results A total of 170 eligible patients were included in the analysis.The basic characteristics were as follows:the average age was 74 years old(51~95 years old);92 patients were male;CHA2 DS2-VASc scores were all≥3;HAS-BLED score of 81 cases were≥3.There were 98 cases(57.65%)receiving anticoagulant therapy on discharge.Multivariate Logistic regression analysis showed that the use of antithrombotic drugs before admission(OR=2.497,P=0.039)and anticoagulation recommendation from clinical consultation(OR=19.842,P<0.001)could help patients to accept anticoagulation therapy,while bleeding events(OR=0.331,P=0.029)and patients'refusal of anticoagulation(OR=0.006,P<0.001)didn't help patients to accept anticoagulation therapy.Conclusion The anticoagulant therapy is not perfect.Raising consultants'awareness and improving patients'rational understanding and compliance with anticoagulant therapy have positive significance to improve the situation.