208例非瓣膜性心房颤动患者消化道出血后重启抗凝用药分析

Restarting anticoagulant drugs after gastrointestinal bleeding events in patients with nonvalvular atrial fibrillation:an analysis of 208 cases

目的回顾性分析消化道出血(Gastrointestinal bleeding,GIB)事件后非瓣膜性心房颤动(Non-valvular atrial fibrillation,NVAF)患者抗凝药物重启情况及抗凝治疗特征。方法选取绵阳富临医院2020年3月至2023年3月经历GIB事件后停用抗凝药物的NVAF住院患者,出血控制后筛选其中有明确抗凝指征(CHA2DS2-VASC男性≥2分或女性≥3分)且无抗凝禁忌的患者208例,收集患者基本资料并观察以下指标:①抗凝重启率;②GIB事件分类;③出血原因;④CHA2DS2-VASC/HAS-BLED评分;⑤重启药物方案。结果208例患者中51例(24.5%)重启抗凝,CHA2DS2-VASC评分<5分与≥5分抗凝重启率差异无统计学意义(22.4%vs.26.0%,P>0.05),出血风险低危组重启率高于高危组(40.7%vs.18.1%,P<0.01)。绝大多数GIB事件为非大出血,追溯到潜在的GIB事件发生风险因素53项,其中低于50%被积极纠正或消除。临床重启抗凝时,多倾向于选用低剂量新型口服抗凝药物(New oral anticoagulants,NOACs)。结论NVAF患者GIB事件后存在重启抗凝率低、关注出血风险而忽略栓塞风险、不重视纠正出血危险因素的问题。

Objective To retrospectively analyze the restart of anticoagulant drugs and the characteristics of anticoagulation therapy after gastrointestinal bleeding(GIB)events in patients with non-valvular atrial fibrillation(NVAF).Methods NVAF inpatients who discontinued anticoagulation after experiencing a GIB event from March 2020 to March 2023 in Mianyang Fulin Hospital were selected,and 208 patients with clear indications for anticoagulation(CHA2DS2-VASC≥2 points in men or≥3 points in women)and no obvious contraindications to anticoagulation were screened.Basic data of patients were collected and the following indicators were observed:①anticoagulation restart rate;②GIB event classification;③cause of bleeding;④CHA2DS2-VASC/HAS-BLED score;⑤restart drug regimen.Results Fifty-one of the 208 patients(24.5%)restarted anticoagulation,and the anticoagulation restart rate was comparable between group with CHA2DS2-VASC score<5 and the group with the score≥5(22.4%vs.26.0%,P>0.05).The restart rate of low-risk bleeding group was higher than that of high-risk bleeding group(40.7%vs.18.1%,P<0.01).The majority of GIB events were non-major bleeding,53 cases could be traced to the probable cause of GIB events,and<50%of bleeding risk factors were actively corrected or eliminated.Low-dose new oral anticoagulants(NOACs)are often preferred for clinical restart of anticoagulation.Conclusion There are some problems after GIB events in NVAF patients,including a low rate of restarting anticoagulation,a focus on bleeding risk at the expense of embolic risk,and a lack of attention to correcting bleeding risk factors.