Rate of anticoagulant use, and factors associated with not prescribing anticoagulant in older Thai adults with non-valvular atrial fibrillation: A multicenter registry

Objectives To investigate the rate of anticoagulant use,the reasons for not prescribing anticoagulant,and the factors associated with non-prescription of anticoagulant in older Thai adults with non-valvular atrial fibrillation.Methods A multicenter registry of patients with non-valvular atrial fibrillation was conducted during 2014 to 2017 in Thailand.Demographic,medical history,antithrombotic medication,non-antithrombotic medication,and laboratory data were collected and analyzed.Data were compared between the older adult (≥ 65 years) and younger adult (< 65 years) groups.The reasons why anticoagulant was not prescribed were collected,and predictive factors were identified.Results A total of 3218 patients (1873 males) with an average age of 67.3 ± 11.3 years were included.Almost two-thirds (61.0%) of patients were in the older adult group.Anticoagulant was prescribed in 2422 patients (75.3%): 81.4% in the older adult group and 65.7% in the younger adult group.The three main reasons for not prescribing anticoagulant were already taking antiplatelets,patient refusal,and bleeding risk.These reasons were more common in older adults as compared to younger adults.Multivariate analysis revealed current use of antiplatelets to be the most important factor that predict the non-prescription of anticoagulant in older population.Conclusions The prevalence of anticoagulant prescription among older Thai adults with atrial fibrillation is 81.4%.Taking antiplatelet drugs was found to be the strongest reason that predicts the non-prescription of anticoagulant in this patient population.A guideline should be developed to optimize the use of anticoagulant and antiplatelet in older adults.

Hyperuricemia predicted adverse outcomes in very elderly patients with non-valvular atrial fibrillation

Objective Elevated serum uric acid predicts poor outcomes in patients with cardiovascular disease.We aimed to examine associations between hyperuricemia and clinical outcomes among very elderly patients with non-valvular atrial fibrillation(NVAF).Methods Elderly patients(≥80 years)with NVAF admitted to our hospital from January 2009 to December 2015 were retrospectively studied and were followed up until April 2017.

The relationship between polymorphisms of P-selectin genes and plasma P-selectin concentration with thrombosis in non-valvular atrial fibrillation of Kazakh ethnicity

Objective:To explore the relationship between polymorphisms in rs1800807 and rs1800808 locies of P-selectin gene and plasma concentrations of soluble P-selectin(sPs)and non-valvular atrial fibrillation(Af)coupled with thrombosis in Kazakh ethnicity.Methods:This was a case-control study,enrolling hospitalized Kazakh Af patients with and without thrombosis and healthy subjects.PCR-RFLP method was used to analyze the polymorphisms of the locies,and ELISA method was to measure plasma sPs concentrations.Subjects were divided into Af thrombosis,only Af and control groups.Results:We enrolled 42 Af thrombosis,156 only Af and 307 control subjects.Carriers of GG genotype of the loci rs1800807 was the highest in Af thrombosis,followed by only Af and the lowest in the control groups(69 vs 23.7 vs 18.2%,P<0.001).Carriers of TT genotype of the loci rs1800808 was the highest in Af thrombosis,followed by only Af and the lowest in the control groups(31.0 vs 13.5 vs 8.1%,P<0.001).Plasma sPs concentrations was the highest in Af thrombosis group,followed by only Af group and the lowest in the control(52.20 vs 34.04 vs 35.85pg/mL,P<0.001).Plasma sPs concentrations were significantly higher in the carriers of GG genotypes of the loci rs1800807 than in those of CC and CG genotypes(45.75 vs 33.86 vs 39.26pg/mL,P<0.001)and also significantly higher in the carries of TT of the loci rs1800808 than in those of CC and CT(43.16 vs 36.74 vs 39.08pg/mL,P<0.001).GG type of rs1800807 loci(OR=3.35,95%CI:2.03-5.55)and TT type of rs1800808(OR=2.19,95%CI:1.65-2.90)showed significantly higher odd's ratio for Af thrombosis,compared with the wild genotype and the highest tertile of plasma sPs aslo showed higher odd's ratio(OR=1.31,95CI%:1.12-1.93),compared with the lowest tertile.Conclusion:polymorphisms of the locies of the PS gene were observed to exist in Af patients with thrombosis and with higher concentrations of plamsa sPs,suggesting their involvement in Af and thrombosis in Kazakh subjects.

Analysis of the Impact Factors on a Stable Warfarin Dose in Extreme Elderly (Age ≥ 80 Years) Chinese Patients with Non-Valvular Atrial Fibrillation

Purpose: The aim of this study was to investigate non-genetic and genetic factors contributing to stable warfarin dose change in the extreme elderly patients with non-valvular atrial fibrillation. Methods: A total of 40 elderly patients with stable warfarin doses were included in this study. Clinical basic data, such as age, sex, body mass index, basic disease like hypertension, diabetes and coronary heart disease had been recorded. Two nucleotide polymorphisms about VKORC1-1639G^A and CYP2C9 1075A^C genes were detected via sequencing by hybridization. Results: The elderly patients with CYP2C9 1075A^C (CA) genotype needed less warfarin daily doses than those?with CYP2C9 1075A^C (AA) genotype (1.93 ± 0.79 mg/d VS 2.15 ± 0.64 mg/d), but there was no significant difference (p = 0.601). While the daily warfarin dose required for patients with VKORC1-1639G^A (AA) genotype was significantly lower than that for patients with VKORC1-1639G^A (GA) genotype (2.00 ± 0.67 mg/d VS 2.63 ± 0.38 mg/d, p = 0.012). VKORC1-1639G^A together with age and diabetes status accounted 41.7% for dose variability. The new algorithm was developed using multivariate linear regression analysis;the model was developed for: Dose = 7.731 – 0.056 * age + 0.527 * DM - 0.785 * VKORC1. Conclusions: VKORC1-1639G^A together with age and diabetes status might predict warfarin doses in age ≥ 80 years patients with non-valvularatrial fibrillation. In contrast, the polymorphism of CYP2C9 1075A^C was not associated with dose variability.

Atrial Myocardial Deformation Changes in Patients with Non-Valvular Atrial Fibrillation

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. It increases cardiovascular morbidity, especially embolic stroke and mortality. Two-dimensional speckle tracking echocardiography (2D STE) is a useful method that has been used to detect changes in atrial myocardial deformation in AF patients. Objectives: To study atrial myocardial deformation changes in patient with non-valvular AF using 2D STE. Patients and Methods: This study included 25 patients with non-valvular AF and 25 normal healthy controls. 2D STE was used for assessment of strain and strain rate of septal and free walls of both right atrium (RA) and LA and left ventricle (LV). Results: Mean LA septal and lateral strain and strain rate were significantly reduced in the AF group compared to the control group (-7.2% ± 5.2% vs. -20.4% ± 3.9%, -8.7% ± 8.8% vs. -21.7% ± 3.4%) and (-0.9 ± 0.5 S-1 vs. -1.9 ± 0.4 S-1, –1.1 ± 0.6 S-1 vs. -2.04 ± 0.3 S-1) respectively. Mean RA septal and lateral strain and strain rate were significantly reduced in the AF group compared to the control group (-5.9% ± 6.1% vs. -23.4% ± 4.5%, -8.9% ± 9.3% vs. -21.7% ± 3.4%) and (-0.98 ± 0.6 S-1 vs. -1.9 ± 0.3 S-1, -1.3 ± 0.9 S-1 vs. -2.1 ± 0.5 S-1) respectively. Mean LV global longitudinal strain (GLS) and strain rate were significantly reduced in the AF group compared to the control group (-8.8% ± 4.6% vs -19.6% ± 2.4%) and (-0.8 ± 0.3 S-1 vs -1.5 ± 0.4 S-1) respectively (P < 0.001 for all). Conclusion: AF is a bi-atrial disease, LA and RA myocardial deformation properties as well as LV GLS and strain rate measured by 2D STE were significantly impaired in AF patients compared to healthy controls.

Optimal INR level in elderly and non-elderly patients with atrial fibrillation receiving warfarin: a report from the COOL-AF nationwide registry in Thailand

Background Asian population are at increased risk of bleeding during the warfarin treatment,so the recommended optimal international normalized ratio(INR)level may be lower in Asians than in Westerners.The aim of this prospective multicenter study was to determine the optimal INR level in Thai patients with non-valvular atrial fibrillation(NVAF).Methods Patients with NVAF who were on warfarin for stroke prevention were recruited from 27 hospitals in the nationwide COOL-AF registry in Thailand.We collected demographic data,medical history,risk factors for stroke and bleeding,concomitant disease,electrocardiogram and laboratory data including INR and antithrombotic medications.Outcome measurements included ischemic stroke/transient ischemic attack(TIA)and major bleeding.Optimal INR level was assessed by the calculation of incidence density for six INR ranges(<1.5,1.5–1.99,2–2.49,2.5–2.99,3–3.49,and≥3.5).Results A total of 2,232 patients were included.The mean age of patients was 68.5±10.6 years.The mean follow-up duration was 25.7±10.6 months.There were 63 ischemic stroke/TIA and 112 major bleeding events.The lowest prevalence of ischemic stroke/TIA and major bleeding events occurred within the INR range of 2.0–2.99 for patients<70 years and 1.5–2.99 for patients≥70 years.Conclusions The INR range associated with the lowest risk of ischemic stroke/TIA and bleeding in the Thai population was 2.0–2.99 for patients<70 years and 1.5–2.99 for patients≥70 years.The rates of major bleeding and ischemic stroke/TIA were both higher than the rates reported in Western population.

低于说明书推荐剂量利伐沙班在亚洲NVAF患者中的研究进展

利伐沙班用于预防非瓣膜性房颤(non-valvular atrial fibrillation,NVAF)患者卒中已有明确的推荐剂量,但亚洲不同国家/地区批准用于NVAF患者卒中预防的利伐沙班推荐剂量存在差异。而且由于缺乏高证据级别的研究数据支持,目前亚洲相关研究对NVAF患者使用低于说明书推荐的利伐沙班剂量抗凝的有效性和安全性的评价存在不一致。本文对亚洲NVAF患者使用利伐沙班在各指南/共识中的应用剂量推荐、亚洲人群抗凝特点和临床研究现状等方面进行分析总结,为临床合理使用利伐沙班提供参考。

炙甘草汤加减联合美托洛尔治疗非瓣膜性房颤临床观察

目的:观察炙甘草汤加减联合美托洛尔治疗非瓣膜性房颤(NVAF)的效果。方法:92例随机分为两组各46例。两组均给予美托洛尔治疗,观察组加用炙甘草汤加减。结果:总有效率观察组高于对照组(P<0.05)。治疗后观察组心悸怔忡、五心烦热、气短乏力、失眠多梦评分及左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左房内径(LAD)、ICAM-1低于对照组,左室射血分数(LVEF)、tPA高于对照组(P<0.05)。两组不良反应相当(P>0.05)。结论:炙甘草汤加减联合美托洛尔治疗NVAF效果较好,且无严重不良反应。

Situation of antithrombotic therapy in elderly patients with atrial fibrillation and acute coronary syndrome

Background Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. The study examines the situation of antithrombotic therapy in elderly patients （more than 60 years old） with non-valvular atrial fibrillation （NVAF） and acute coronary syndrome （ACS） / percutaneous coronary intervention （PCI）. Methods This study enrolled 381 elderly patients Emean age （69.95 ± 8.41） years; 289 males, 92 femalesl with NVAF and ACS/PCI between January 2006 and September 2013. According to clinical data, these patients were categorized into 4 groups： triple therapy （TT） group, dual antiplatelet therapy （DAT） group, vitamin K antagonist （VKA） plus single antiplatelet therapy （SAT） group and VKA group. According to score of CHA2DS2-VASc and HAS-BLED, all the patients were divided into 4 combinations. Statistical methods were used to analyze the situation of antithrombotic therapy and potential associations between the different combinations. Results 38 patients （9.97%） received TT and 300 patients （78.74%） received DAT. TT was received in 20 patients with CHA2DS2-VASc ≥2 and HAS-BLED ≥3, and 16 patients with CHA2DS2- VASc≥2 and HAS-BLED 〈 3. Conclusions Elderly patients who suffered NVAF and ACS/PCI were with high risk of stroke and low risk of bleeding. Majority of these patients received DAT instead of TT.

华法林应用初期INR变化的分析

目的观察非瓣膜病房颤(NVAF)患者应用不同起始剂量华法林,在不同时间国际标准化比值(international nor-malized ratio;I NR)的变化,比较不同时间I NR的达标率、I NR达稳定的时间差异、出血并发症的发生率。方法入选具有华法林抗凝适应证的NVAF患者53例,随机分为2组,分别以5mg/d或3mg/d起始治疗,于治疗第3、4、5、8天测定I NR,根据I NR调整华法林剂量,直到I NR稳定。结果与3mg/d组相比,5mg/d组I NR变化速度较快,第4、8天I NR的达标率显著高于3mg/d组;I NR达稳定的时间缩短[(10.5±2.5)d比(12.2±2.9)d,P=0.03)],出血并发症并不增加。结论5mg/d起始华法林治疗能使I NR迅速、安全且有效地达到稳定,而不增加出血并发症。

CHA_2DS_2-VASc评分在非瓣膜性房颤缺血性脑卒中患者中的应用

目的研究CHA2DS2-VASe评分与颅内动脉粥样硬化、卒中分型、早期预后的关系，以评价CHA2DS2-VASc评分的临床价值。方法回顾性分析149例非瓣膜性房颤（non-valvular atrial fibrillation，NVAF）缺血性脑卒中患者的临床表现、常规实验室检查、彩超和颅脑CT等辅助检查，以及CHA：DS：一VASc评分、中国缺血性卒中亚型（Chinese ischemic stroke subclassification，CISS）分型、人院和出院时美国国立卫生研究院卒中量表（Na-tional Institutes of Health stroke scale，NIHSS）评分等。结果合并颅内动脉粥样硬化的患者以及CHA2DS2-VASc评分高于未合并者[（5．13±1．39）vs．（4．14±1．67）】，差异有统计学意义（P〈0．05）；不同CHA2DS2-VASc评分组（0-1分组，2-3分组，4-5分组，≥6分组）患者合并颅内动脉硬化的分布情况有统计学差异（P〈0．05）。CS＋LAA组与CS＋LAA＋PAD组患者CHA2DS2-VASc评分分别与CS组、CS＋PAD组患者比较均有统计学差异（均P〈0．01）。不同CHA：DS：-VASc评分组患者病情改善情况比较有统计学差异（P〈0．05）；病情改善组与未改善组的患者CHA2DS2-VASc评分比较亦存在统计学差异（P〈0．05）。结论较高的CHA2DS2-VASc评分与NVAF缺血性脑卒中患者合并颅内动脉粥样硬化机率增加有关；CHA2DS2-VASc评分可以帮助推测NVAF患者发生缺血性脑卒中的类型和发病机制；CHA2DS2-VASc评分与NVAF缺血性脑卒中严重程度及早期病情改善相关。

不同抗凝强度华法林对中国和日本非瓣膜性房颤患者出血与栓塞事件影响的Meta分析

目的探讨不同抗凝强度的华法林对中国和日本非瓣膜性房颤患者出血与栓塞事件的影响。方法检索Pubmed、EMbase、Cochrane Central Register of Controlled Trials(CENTRAL)、中国生物医学文献库)CBM)数据库,收集不同抗凝强度华法林治疗非瓣膜性心房颤动的观察性研究,用Rev Man 5.3软件统计分析。结果共纳入5篇文章。Meta分析显示:与INR(国际标准化比值)2.0~3.0相比,INR 1.5~2.5组的非瓣膜性心房颤动患者的栓塞事件没有增加[OR=1.26,95%CI=(0.96,1.66),Z=1.66,P=0.10];出血风险[OR=0.81,95%CI=(0.63,1.05),Z=1.61,P=0.11])、致命性出血[OR=0.75,95%CI=(0.47,1.19),Z=1.22,P=0.22]和死亡事件[OR=1.22,95%CI=(0.86,1.73),Z=1.12,P=0.26]发生的风险亦无统计学意义的变化。结论中日非瓣膜性房颤接受华法林抗凝治疗患者,其INR维持在1.5~2.5能达到治疗目的,且相对安全,临床可适当调整INR的标准。

利伐沙班预算影响分析

目的 :本研究以成人深静脉血栓形成与成人非瓣膜性房颤卒中预防被纳入医保目录为假设,从医疗总费用和医保支付费用的两个维度对比分析2017版医保目录执行前后,利伐沙班3个适应症人群医疗总费用(患者抗凝药物费用,抗凝诊疗费用,并发症治疗费用)和医保基金支出的变化情况。方法 :基于国际药物经济学与结果研究协会公布的预算影响分析指南,采用Excel构建1个跨度5年的模型。模型中,适应症人群患病率和发病率的数据来源文献分析,直接医疗成本等数据来源于从医疗机构采集的费用信息分析,利伐沙班的用药人群比例等预测值来源于专家意见。结果 :若利伐沙班3种适应症均被医保报销,1-5年节省医疗总费用分别为31,590.89万元、30,516.92万元、29,228.16万元、27,681.65万元、25,825.84万元,节省医保基金支出分别为7,793.73万元、7,243.15万元、6,582.46万元、5,789.64万元、4,838.24万元。其中,对房颤患者用药依从性、患者药物可及性及用药人群增长比例分别进行敏感性分析,研究结论未发生改变,说明基础分析结果具有稳健性。结论 :若利伐沙班3种适应症均被医保报销能节省医疗总费用和医保基金支出,将起到优化卫生资源配置的作用。

非瓣膜性心房颤动住院患者抗凝治疗的单中心调查分析

目的:调查分析非瓣膜性心房颤动(NVAF)住院患者抗凝治疗情况,为规范化抗凝治疗提供参考.方法:将NVAF患者按入院时间分为3组:2007~2010年(A组)、2011~2014年(B组)和2015~2017年(C组).调查3组患者抗凝及抗血小板药物使用情况,并进行栓塞及出血风险评估,对比分析不同栓塞风险、出血风险及不同组别间患者的抗凝治疗情况.结果:NVAF患者抗凝治疗率由4.15%(A组)上升至29.00%(C组),C组患者的抗凝治疗率较前显著增加(x^2=133.31,P<0.001).结论:NVAF患者的抗凝治疗较前有所改善,临床上应加强有效干预措施以提高抗凝治疗规范化程度.

非瓣膜性房颤患者缺血性卒中的危险因素及其与短期预后的关系

目的探讨非瓣膜性房颤(NVAF)患者缺血性卒中(IS)的危险因素及其与短期预后的关系。方法选取2017年9月至2019年9月我院收治的NVAF合并IS患者113例为观察组,选取同期未合并IS的NVAF患者200例为对照组。记录两组临床资料及颈动脉粥样硬化(CAS)检出率。采用多因素Logistic回归分析CAS与IS的关系,记录IS短期预后的危险因素,采用偏相关分析评估CAS与IS短期预后的关系。结果观察组年龄、收缩压、舒张压、高血压、抗血小板药物及他汀类药物用药率均高于对照组(P<0.05)。观察组动脉内中膜厚度(IMT)增厚(78.7%vs. 62.00%)和颈动脉斑块检出率(69.03%vs. 48.00%)均高于对照组(P<0.05)。IMT增厚、颈动脉斑块、稳定性斑块、不稳定性斑块均是CAS患者发生IS的危险因素(P<0.05)。IS短期预后情况的年龄、收缩压、舒张压、高血压、他汀类药物用药率比较,差异均有统计学意义(P<0.05)。卒中再发、转归不佳、死亡情况的抗血小板药物用药率比较,神经功能缺损、转归不佳、死亡情况的颈动脉斑块检出率比较,差异均有统计学意义(P<0.05)。抗血小板药物和他汀类药物均与卒中再发、神经功能缺损、转归不佳、死亡均呈负相关(r=-0.631、-0.572、-0.610、-0.514,P<0.05;r=-0.729、-0.605、-0.636、-0.537,P<0.05),颈动脉斑块与神经功能缺损、转归不佳、死亡均呈正相关(r=0.580、0.553、0.625,P<0.05)。结论 NVAF患者具有较大的CAS风险,且与IS的发生密切相关。同时,CAS与NVAF患者IS短期预后具有一定的关系,CAS患者发生不良预后的几率更大。

多普勒超声联合CT检查在非瓣膜性房颤患者血流动力学与凝血功能评估中的临床价值研究

目的:采用多普勒超声联合CT检查进行血流动力学与凝血功能评估,探讨其在非瓣膜性心房颤动(NVAF)患者诊断中的临床价值。方法:选取医院心内科接诊的200例NVAF患者,将未经抗凝治疗的100例NVAF患者纳入观察组,将心血管系统未见异常的100例NVAF患者纳入对照组。所有患者均采用超声心动图进行血流动力学指标的评估,并通过CT增强扫描进行血栓栓塞情况的检测,对左心房内径(LAD)、左心室舒张末内径(LVEDD)及左心室射血分数(LVEF)进行测评,采用受试者工作特征(ROC)曲线下面积(AUC)比较多普勒超声联合CT检查的诊断效能。结果:两组患者的年龄、体重指数、收缩压、舒张压、NVAF病程等基本资料比较无差异;观察组患者超声心动图测量LAD、LVEDD及LVEF的数值劣于对照组,差异有统计学意义(t=15.095,t=6.862,t=3.349;P<0.05);观察组患者头颅、肺动脉和心脏冠状动脉的血栓栓塞比例高于对照组,差异有统计学意义(x^(2)=24.100,x^(2)=13.580,x^(2)=34.621;P<0.05);以心电图为诊断标准,超声心动图诊断NVAF的AUC、灵敏度和特异度分别为0.892、89.1%和87.0%;CT影像诊断分别为0.913、84.5%和86.2%;超声联合CT诊断分别为0.946、96.7%和90.5%。结论:NVAF患者的血流动力学指标明显下降,凝血功能出现异常,多普勒超声联合CT检查方法能更准确地评估患者的生理状态和健康水平,为临床NVAF患者的治疗提供更全面的数据依据。

左心房内径联合心脏节律预测非瓣膜性心房颤动患者左心耳血栓形成的价值

目的:评估临床及心脏超声指标预测非瓣膜性心房颤动患者左心耳血栓形成的价值。方法:非瓣膜性心房颤动患者688例,以经食管超声心动图检查结果分为左心耳血栓组(38例)和无血栓组(650例)。对两组患者临床特征及经胸超声心动图检查结果进行统计分析,筛选血栓形成的影响因素并评价其预测效力。结果:与无血栓组比较,血栓组患者检查时窦性心律比例和LVEF更低,合并心力衰竭比例、CHA2DS2-VASc评分、三尖瓣反流、IVST、LVPWT、LAD、RADz和RADl均更高。Logistic回归分析显示LAD和心脏节律是血栓形成的独立影响因素。ROC曲线以LAD 43.55 mm为截值预测血栓形成的敏感度为92.1%,特异性为59.7%,曲线下面积0.805(P<0.001,95%CI 0.751~0.859)。LAD联合心脏节律预测的曲线下面积达0.810(P<0.001,95%CI 0.749~0.870)。结论:LAD是非瓣膜性心房颤动患者左心耳血栓形成强有力的影响因素,LAD联合心脏节律可提高预测左心耳血栓形成的效力。

非瓣膜性房颤患者抗凝药物使用现状分析

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。

基于临床参考及基因因素建立华法林稳定维持剂量预测模型

目的探讨华法林应用的临床参考因素及基因因素与华法林稳定维持剂量的相关性,并尝试构建适用于非瓣膜病心房纤颤(non-valvular-disease atrial fibrillation,NVAF)患者华法林稳定维持剂量的预测模型。方法按照纳入标准共纳入126例患者,应用测序反应通用试剂盒及荧光检测仪检测细胞色素P450 2C9和维生素K环氧化物还原酶基因多态性,同时记录华法林应用的临床参考因素:年龄、体质量、房颤栓塞风险评分系统(CHA_2DS_2-VASc)评分、房颤出血风险评分系统(HAS-BLED)评分、谷丙转氨酶(glutamic-pyruvic transaminase,ALT)、肾小球滤过率(glomerular filtration rate,GFR)、左心室射血分数(left ventricular ejection fraction,LVEF)、二尖瓣环水平左室侧壁组织多普勒S波;采用相关性分析探讨临床参考因素及基因多态性与华法林稳定维持剂量的相关性,并通过多元线性回归建立了华法林稳定维持剂量预测模型。结果体质量、ALT水平、二尖瓣环水平左室侧壁组织多普勒S波与华法林稳定维持剂量成正相关,年龄、CHA_2DS_2-VASc评分、HAS-BLED评分则成负相关,而LVEF、GFR未显示明显的相关性。建立的预测模型对已有样本验证准确率达55.6%。结论该模型可用于预测NVAF患者华法林稳定维持剂量。