门诊心房颤动患者抗凝治疗现状调查分析

Investigation and analysis about the current status of anticoagulation therapy in outpatients with atrial fibrillation

目的 调查分析现阶段心房颤动(房颤)患者的流行病学特征和抗凝治疗现状,为促进与规范房颤患者的抗凝治疗提供参考依据。方法 通过合理用药监测系统(PASS)及门诊病历系统提取2018年1—12月在玉林市第一人民医院门诊就诊的851例房颤患者,收集患者的临床信息、合并疾病、伴随用药、抗栓治疗药物等资料。将入组患者根据有无卒中病史分为脑卒中组(n=161)和非脑卒中组(n=690),同时根据房颤病因分为瓣膜性房颤组(n=164)、非瓣膜房颤(NVAF)卒中组(n=130)和NVAF非卒中组(n=557)。根据房颤相关诊疗指南,采用CHA_(2)DS_(2)-VASc评分对所有NVAF患者进行卒中风险评估,分析房颤患者的临床特征和抗栓药物的实际应用情况,评价其抗凝方案的合理性。结果 851例患者平均年龄为(66.4±12.4)岁,合并疾病排名前五位依次为心力衰竭(56.2%)、高血压(40.7%)、冠心病(32.1%)、高脂血脂(15.3%)和糖尿病(10.0%)。NVAF患者占80.7%。18.9%的房颤患者合并脑卒中病史。所有患者总抗凝治疗率为62.3%,单纯抗血小板治疗率为17.9%;在接受抗凝治疗患者中,47.7%使用新型口服抗凝药(NOAC)。瓣膜性房颤组抗凝治疗率76.2%,高于NVAF组(P<0.001)。NVAF患者CHA_(2)DS_(2)-VASc评分分值在0~5分,抗凝比例较高,但分值≥6分时,抗凝比例逐渐下降;随着评分分值的升高,总体单纯抗血小板比例逐渐增加。50.1%的入组患者存在治疗不当、过度治疗或未治疗。结论 目前房颤患者以NVAF为主,其总抗凝治疗率仍偏低,且治疗极不规范,应采取积极措施以提高抗凝治疗的合理率。

Objective To investigate the epidemiological characteristics and the current status of anticoagulation therapy in patients with atrial fibrillation(AF),and provide a reference basis for promoting and standardizing the anticoagulant therapy in patients with AF.Methods We extracted data on outpatients with AF in the First People’s Hospital of Yulin from January 2018 to December 2018 by prescription automatic screening system(PASS)and outpatient medical records system,the clinical date including baseline clinical characteristics,coexistent disease,concomitant medications and antithrombotic drugs.The enrolled patients were divided into stroke group and non-stroke group according to their hostory of strake,and patients were divided into valvular atrial fibrillation group,NVAF stroke group and NVAF non-stroke group according to the etiology of atrial fibrillation.The stroke risk of patients with non-valvular atrial fibrillation(NVAF)was evaluated by CHA_(2)DS_(2)-VASc score.According to the relevant diagnosis and treatment guidelines for AF,the clinical characteristics and actual application of antithrombotic drugs was analyzed,and the rationality of the anticoagulant regimen were evaluated.Results A total of 851 patients were enrolled in this study,the mean age of these patients was(66.4±12.4)years.The five top-ranked coexistent disease were heart failure(56.2%),hypertension(40.7%),coronary heart disease(32.1%),hyperlipidemia(15.3%)and diabetes(10.0%).About 80.7%AF patients were diagnosed with NVAF,and 18.9%had stroke history.The overall anticoagulant rate was 62.3%and the antiplatelet rate was 17.9%.47.7%of patients receiving anticoagulation therapy used new oral anticoagulants(NOAC).The anticoagulation rate of the valvular atrial fibrillation group was 76.2%,higher than the NVAF group(P<0.001).When CHA_(2)DS_(2)-VASc scores of NVAF patients were 0 to 5,the anticoagulation rate showed a relatively high level.When the scores were≥6,the anticoagulation rate was in decline.The antiplatelet ratio increased gradually with increased scores.50.1%of enrolled patients were either inadequately treated,over-treated,or un-treated.Conclusion Patients with NVAF are the main type of patients with AF.The rate of anticoagulation therapy in patients with AF is still low at present,and the treatment is extremely irregular.Positive measures should be taken to improve the reasonable rate of anticoagulation therapy.