非瓣膜性心房颤动患者136例抗栓治疗现状分析

Analysis of current status of antithrombotic therapy in 136 patients with nonvalvular atrial fibrillation

目的分析非瓣膜性心房颤动患者不同抗栓方案的治疗现状及有效性。方法回顾性分析永康市第二人民医院2018年5月至2019年5月收治的非瓣膜性心房颤动患者136例的临床资料。根据治疗方案分为无抗栓组(32例)、利伐沙班组(41例)、华法林组(42例)、阿司匹林组(21例)。在治疗原发病和合并症的同时,无抗栓组不用抗凝或抗血小板治疗;利伐沙班组给予利伐沙班10 mg/d治疗;华法林组给予华法林2.5 mg/d治疗;阿司匹林组给予阿司匹林0.1 g/d治疗;观察比较各组1年内血栓栓塞及出血事件发生率、全因死亡率、再入院率等。结果各组患者年龄、房颤类型及合并冠心病、心力衰竭、高血压等差异均有统计学意义(均P<0.05),而各组患者性别、脑卒中/短暂性脑缺血发作史、合并糖尿病和高脂血症等差异均无统计学意义(均P>0.05)。1年内,无抗栓组、利伐沙班组、华法林组、阿司匹林组总血栓栓塞事件发生率分别为21.87%(7/32)、7.32%(3/41)、2.38%(1/42)、19.05%(4/21),差异有统计学意义(χ^(2)=8.98,P<0.05),各组出血事件发生率分别为18.75%(6/32)、29.27%(12/41)、4.76%(2/42)、4.76%(61/21),差异有统计学意义(χ^(2)=11.77,P<0.05);1年内,<65岁、65~75岁、>75岁各年龄段患者总血栓栓塞事件、总出血事件发生率比较,差异均无统计学意义(均P>0.05),全因死亡、再入院发生率差异均有统计学意义(χ^(2)=6.76、7.56,均P<0.05)。结论对非瓣膜性心房颤动患者早期抗栓治疗非常重要,治疗方案应遵循个体化,患者年龄增加死亡风险增大。

Objective To analyze the current status and effectiveness of different antithrombotic regimens in patients with non-valvular atrial fibrillation.Methods The clinical data of 136 patients with non-valvular atrial fibrillation who received treatment in The Second People's Hospital of Yongkang from May 2018 to May 2019 were retrospectively analyzed.According to the treatment plan,they were divided into no antithrombosis group(n=32),rivaroxaban group(n=41),warfarin group(n=42),and aspirin group(n=21).Based on treatment of primary disease and complications,patients in the no antithrombosis group were not given anticoagulation or antiplatelet therapy,those in the rivarxaban group were given rivarxaban(10 mg/d),those in the warfarin group were given warfarin(2.5 mg/d),and those in the aspirin group were given aspirin(0.1 g/d).The incidence of thromboembolism and bleeding,all-cause mortality and readmission rate within 1 year were compared among groups.Results There were significant differences in age,type of atrial fibrillation,coronary heart disease,heart failure,and hypertension among groups(all P<0.05).There were no significant differences in sex,history of stroke/transient ischemic attack,and the percentage of patients developing diabetes mellitus and hyperlipidemia among groups(all P>0.05).The incidence of thromboembolic events within 1 year in the no antithrombosis,rivaroxaban,warfarin,and aspirin groups were 21.87%(7/32),7.32%(3/41),2.38%(1/42),and 19.05%(4/21),respectively,and there were significant differences among groups(χ^(2)=8.98,P<0.05).The 1-year incidence of bleeding events in the no antithrombosis,rivaroxaban,warfarin,and aspirin groups were 18.75%(6/32),29.27%(12/41),4.76%(2/42),4.76%(61/21),respectively,and there were significant differences among groups(χ^(2)=11.77,P<0.05).There were no significant differences in the 1-year incidence of thromboembolism events and bleeding events among patients aged<65 years,65-75 years,and>75 years(all P>0.05),but there were significant difference in all-cause mortality and readmission rate(χ^(2)=6.76,7.56,both P<0.05).Conclusion Early antithrombotic therapy is very important for patients with non valvular atrial fibrillation.The treatment regimens should be individualized,and the risk of death increases with age.