非瓣膜病心房颤动患者发生血栓栓塞事件前的抗凝情况调查

Investigation of oral anticoagulants prior to thromboembolic events in patients with the awareness of their atrial fibrillation diagnosis

目的调查已知非瓣膜病心房颤动(NVAF)患者在血栓栓塞事件前的抗凝情况,并分析医师是否能正确对心房颤动(房颤)患者进行脑卒中风险评估、处方抗凝药物及患者对抗凝药物的态度。方法本研究为横断面研究,连续入选2018年9月至2021年9月在南京医科大学第一附属医院心内科抗凝门诊既往已知NVAF后发生血栓栓塞事件的患者。通过调查问卷方式向患者或患者家属收集资料,主要包括患者的性别、年龄、发生血栓栓塞事件前的抗凝药物使用情况、未使用/停用抗凝药物的原因及伴随疾病等信息。结果入选344例患者,其中男占61.9%(213/344),第1次血栓栓塞事件发生时的年龄为(69.3±10.0)岁。89.5%(308/344)患者血栓栓塞事件发生前CHA2DS2-VASc评分≥1分(男)或≥2分(女),具有抗凝适应证。73.4%(226/308)脑卒中高风险患者从未使用抗凝药物,主要原因为没有医师告知房颤的卒中风险,未建议使用抗凝药物。82例(26.6%,82/308)患者在血栓栓塞事件前曾使用抗凝药物,华法林占61.0%(50/82);其中36例患者血栓栓塞事件前已停用抗凝药物,主要原因为抗凝过程中出现小出血事件;余46例患者在抗凝过程中发生了血栓栓塞事件,其中30例患者抗凝药物使用不规范。结论房颤患者发生血栓栓塞事件的主要原因包括患者对房颤的脑卒中风险不了解、因小出血事件停用抗凝药物及抗凝药物的不规范使用。临床需从医患双方着手,增强临床医生对房颤的认识及脑卒中风险评估能力,进一步规范抗凝治疗,加强患者健康教育,减轻患者对抗凝治疗的顾虑,更好地预防心房颤动相关脑卒中事件的发生。

Objectives To assess the anticoagulation status prior to the thromboembolic events in patients who were aware of their diagnosis of non-valvular atrial fibrillation(NVAF),and investigate whether physicians can correctly assess stroke risk and prescribe oral anticoagulants(OAC)to patients with atrial fibrillation(AF)and patients’attitudes to OAC.Methods This study was a cross-sectional study.Patients were consecutively enrolled from September 2018 to September 2021 from Anticoagulation Clinic in The First Affiliated Hospital of Nanjing Medical University after they were aware of NVAF.Datas were collected using a questionnaire,which included gender,age,use of OAC prior to the first thromboembolic event,factors for not/discontinuation of using OAC and comorbidities.Results A total of 344 patients were enrolled,and 61.9%(213/344)patients were men.OAC was clinically indicated in 308(89.5%,308/344)patients(CHA2DS2-VASc score≥1 of male,and≥2 of female before the thromboembolic events occurred).Of them,226(73.4%,226/308)patients never used OAC mainly because physicians did not recommend OAC,and patients never knew that AF increased the risk of stroke.Eighty-two(26.6%,82/308)patients received OAC before their first thromboembolic events,and 61.0%(50/82)of them took warfarin.Of the 82 patients,36 patients had discontinued OAC prior to their thromboembolic events,mainly because of minor bleeding events during anticoagulation.The other 46 patients had thromboembolic events during anticoagulation,30 of whom had non-standard use of OAC.Conclusion The major reasons for the occurrence of thromboembolic events in patients with AF included unawareness of stroke risk,discontinuation of OAC due to minor bleeding,and inappropriate use of OAC.Increased AF knowledge and improved ability to assess stroke risk for physicians are both necessary.It is important to prioritize standardized OAC treatment.Patients’access to health education needs to be improved.Their concerns about OAC should be alleviated.