非瓣膜性房颤患者抗凝药物使用现状分析

Clinical application of anticoagulant in patients with non-valvular atrial fibrillation

目的调查分析我院非瓣膜性房颤(NVAF)住院患者抗凝药物使用情况并对其临床反应进行评价,以促进临床合理使用抗凝药物。方法采集2015年6月至2017年2月于我院住院的NVAF患者共129例,对患者一般资料(性别、年龄、房颤类型、合并疾病等)、血栓栓塞风险(CHA_2DS_2-VASc评分)、出血风险(HAS-BLED评分)、抗栓药物使用及临床反应情况进行分析评价。结果 129例研究对象中,接受抗凝血药物治疗(抗凝组)26例(20.16%),其中华法林25例(19.38%),达比加群酯1例(0.78%);接受抗血小板治疗(抗血小板组)84例(65.12%),其中阿司匹林54例(41.86%),氯吡格雷26例(20.16%),双抗(阿司匹林和氯吡格雷)3例(2.33%),西洛他唑1例(0.78%);未接受抗栓药物治疗者19例(14.72%)。抗凝组和抗血小板组出血事件分别为3例(11.54%)和6例(7.14%),血栓栓塞事件分别为0例和2例(2.38%),两组患者出血和栓塞事件发生率差异无统计学意义(P>0.05)。结论我院NVAF患者接受合理抗凝药物治疗比例低,临床中仍有一半以上患者使用抗血小板药物治疗,与指南要求尚有一定差距。

Objective To investigate the clinical application status of anticoagulant in hospitalized patients with nonvalvular atrial fibrillation(NVAF) in our hospital and to evaluate the clinical response and their clinical rational use. Methods A total of 129 patients with NVAF from June 2015 to February 2017 were collected. The general data(gender, age, type of atrial fibrillation and combined diseases), the thromboembolism risk(CHA_2DS_2-VASc score), the bleeding risk(HAS-BLED score) and the antithrombotic drugs selection and their clinical response were analyzed and evaluated. Results In 129 patients, 26 cases(20.16%) were treated with anticoagulant therapy, including 25 cases(19.38%) used warfarin and 1 case(0.78%) used dabigatran etexilate; 84 cases(65.12%) were treated with antiplatelet therapy, including 54 cases(41.86%) used aspirin, 26 cases(20.16%) used clopidogrel, 3 cases(2.33%) used double antiplatelet therapy(aspirin and clopidogrel), 1 case(0.78%) used cilostazol; 19 cases(14.72%) were not treated with any antithrombotic drugs. There were 3 cases(11.54%) and 6 cases(7.14%) occurred non-serious hemorrhage events in anticoagulation group and antiplatelet group respectively. The embolization events were 0 case and 2 cases(2.38%) respectively. There were no statistical differences between the two groups in the incidence of both hemorrhage and embolism(P>0.05). Conclusion The proportion of NVAF patients who received reasonable anticoagulant therapy in our hospital is low, and more than half of the patients still use antiplatelet drugs, which is not meet the requirement of guidelines.