单中心非瓣膜病心房颤动患者抗凝治疗状况分析
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摘要
目的探讨非瓣膜病心房颤动患者口服抗凝药治疗的现状及影响因素,以更好地指导临床抗凝治疗。方法选取2017年8月至2018年4月在解放军福州总医院心血管内科诊断为心房颤动的患者,收集临床基础资料和抗凝治疗情况,采用CHA_2DS_2-VASc评分进行卒中风险评估,评价患者的抗凝治疗方案。结果共529例患者入选本研究。395例CHA_2DS_2-VASc评分≥2的患者中,156例(39.5%)接受抗凝治疗(单药或与抗血小板药物联合),137例(34.7%)接受抗血小板治疗,102例(25.8%)未行抗栓治疗。81例CHA_2DS_2-VASc评分为1的患者中,21例(25.9%)接受抗凝治疗(单药或与抗血小板药物联合),35例(43.2%)接受抗血小板治疗,25例(30.9%)未行抗栓治疗。53例CHA_2DS_2-VASc评分为0的患者中,12例(28.3%)接受了抗凝治疗。入组的529例患者中,277例(52.4%)抗栓治疗方案合理,13例(2.5%)治疗过度,137例(25.9%)治疗不足,102例(19.3%)未治疗。189例接受抗凝治疗的患者中,128例(67.7%)服用华法林治疗,61例(32.3%)服用新型口服抗凝药(46例服用达比加群酯,15例服用利伐沙班)。结论本研究非瓣膜病心房颤动患者中74.7%为卒中高危患者,其中61.5%的患者治疗过度、治疗不足或未进行抗栓治疗,应规范抗凝治疗,减少卒中风险。
Objective To analyze the application of anticoagulant therapy and the related factor in the patients with nonvalvular atrial fibrillation(NVAF) so as to better guide clinical anticoagulant therapy. Method The clinical data including baseline clinical characteristics, complications, anticoagulant therapy and risk evaluation of thromboembolism(based on CHA_2 DS_2-VASc score) in patients with NVAF from August 2017 to April 2018 were analyzed. Result A total of 529 patients were enrolled. 395 patients had a CHA_2 DS_2-VASc score≥2, 156(39.5%) patients received anticoagulant therapy(anticoagulant alone or in combination with antiplatelet agents), 137(34.7%) patients were treated with antiplatelet, 102(25.8%) patients did not receive anti-thrombotic treatment. 81 patients had a CHA_2 DS_2-VASc score=1, 21(25.9%) patients received anticoagulant therapy, 35(43.2%) patients were treated with antiplatelet, 25(30.9%) patients did not receive anti-thrombotic treatment. 53 patients had a CHA2 DS2-VASc score=0, 12(28.3%)patients received anticoagulant therapy. Of the 529 patients, 277(52.4%) patients were treated in line with the curent guideline recommendation, 13(2.5%) patients were over-treated, 137(25.9%)patients were treated improperly, 102(19.3%) patients received no anti-thrombotic. 189 patients received anticoagulant therapy, 128(67.7%) patients with warfarin and 61(32.7%) patients with novel oral anticoagulant(NOAC). Conclusion 74.7% NVAF patients were at high risk of thromboembolism. 61.5% of them were either over-treated, inadequately treated or un-treated. It is necessary to improve anti-thrombotic therapy status in patients with NVAF.
Objective To analyze the application of anticoagulant therapy and the related factor in the patients with nonvalvular atrial fibrillation(NVAF) so as to better guide clinical anticoagulant therapy. Method The clinical data including baseline clinical characteristics, complications, anticoagulant therapy and risk evaluation of thromboembolism(based on CHA_2 DS_2-VASc score) in patients with NVAF from August 2017 to April 2018 were analyzed. Result A total of 529 patients were enrolled. 395 patients had a CHA_2 DS_2-VASc score≥2, 156(39.5%) patients received anticoagulant therapy(anticoagulant alone or in combination with antiplatelet agents), 137(34.7%) patients were treated with antiplatelet, 102(25.8%) patients did not receive anti-thrombotic treatment. 81 patients had a CHA_2 DS_2-VASc score=1, 21(25.9%) patients received anticoagulant therapy, 35(43.2%) patients were treated with antiplatelet, 25(30.9%) patients did not receive anti-thrombotic treatment. 53 patients had a CHA2 DS2-VASc score=0, 12(28.3%)patients received anticoagulant therapy. Of the 529 patients, 277(52.4%) patients were treated in line with the curent guideline recommendation, 13(2.5%) patients were over-treated, 137(25.9%)patients were treated improperly, 102(19.3%) patients received no anti-thrombotic. 189 patients received anticoagulant therapy, 128(67.7%) patients with warfarin and 61(32.7%) patients with novel oral anticoagulant(NOAC). Conclusion 74.7% NVAF patients were at high risk of thromboembolism. 61.5% of them were either over-treated, inadequately treated or un-treated. It is necessary to improve anti-thrombotic therapy status in patients with NVAF.
引文
[1]黄从新,张澎,黄德嘉,等.心房颤动:目前的认识和治疗建议-2015[J].中国心脏起搏与心电生理杂志,2015,29(5):377-434.
[2]吴章薇,梅丽平,赵军,等.心房颤动合并脑栓塞患者的抗凝治疗现状和出血转化分析[J].中国卒中杂志,2016,11(1):47-53.
[3]January C,Wann L,Alpert S,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation[J].J Am Coll Cardiol,2014,64(21):E1-E76.
[4]王志尊,王伟,杜昕,等.非瓣膜病心房颤动患者华法林长期抗凝治疗的依从性[J].中华心血管病杂志,2017,45(11):920-923.
[5]崔晶,杜昕,汤日波,等.心内科CHA2DS2-VASc评分对非瓣膜性心房颤动患者左心房血栓发生风险的评估作用及左心房血栓形成的危险因素[J].中国医药,2017,12(10):1441-1444.
[6]高鹏,方全,王佳丽,等.非瓣膜病心房颤动患者抗凝不足状况及原因分析[J].中华心血管病杂志,2013,41(11):931-934.
[7]孙艺红,胡大一.非瓣膜病心房颤动患者全球抗凝注册研究中国亚组基线数据分析[J].中华心血管病杂志,2014,42(10):846-850.
[8]黄华文,曾宪炳,周宏霞.267例老年非瓣膜性心房颤动住院患者的抗凝治疗状况分析[J].广东医科大学学报,2017,35(2):128-130.
[9]那开宪.应重视华法林治疗过程中的影响因素[J].中国临床医生杂志,2016,44(5):1-3,6.
[10]蔡洁玲,孙育民.非维生素K拮抗剂口服抗凝药在亚洲非瓣膜性心房颤动患者中的研究进展[J].中华心律失常学杂志,2017,21(4):302-304.
[11]Connolly J,Ezekowitz M,Yusuf S,et al.Newly identified events in the RE-LY trial[J].New Engl J Med,2010,363(19):1875-1876.
[12]Breithardt G,Baumgartner H,Berkowitz S,et al.Clinical cbaracteristics and outcomes with rivaroxaban vs.warfarin in patients with non-valvular atrial fibrillation but underlying native mitral and aortic valve disease participating in the ROCKET AFtrial[J].Eur Heart J,2014,35(47):3377-3385.
[13]王尹曼,钱菊英.新型口服抗凝药在老年人非瓣膜性心房颤动脑卒中预防中的应用[J].中华心律失常学杂志,2016,20(5):444-447.
[14]胡大一.心房颤动预防血栓栓塞的抗凝药物处方[J].中国医刊,2017,52(4):20-21.
[15]张涛,杨艳敏.心房颤动合并急性冠状动脉综合征患者的抗凝治疗[J].中华心律失常学杂志,2017,21(4):292-294.
[16]Olesen B,Lip Y,Lindhardsen J,et al.Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation:a net clinical benefit analysis using a“real world”nationwide cohort study[J].Thromb Haemost,2011,106(4):739-749.
[17]黄从新,黄德嘉,张澍,等.非瓣膜病心房颤动患者新型口服抗凝药的应用中国专家共识[J].中华心律失常学杂志,2014,18(5):321-32.
[18]郭红雨,段永珂,洪岩,等.达比加群酯与华法林用于非瓣膜性心房颤动患者抗凝的有效性与安全性比较[J].中国药房,2017,28(33):4461-4463.
[2]吴章薇,梅丽平,赵军,等.心房颤动合并脑栓塞患者的抗凝治疗现状和出血转化分析[J].中国卒中杂志,2016,11(1):47-53.
[3]January C,Wann L,Alpert S,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation[J].J Am Coll Cardiol,2014,64(21):E1-E76.
[4]王志尊,王伟,杜昕,等.非瓣膜病心房颤动患者华法林长期抗凝治疗的依从性[J].中华心血管病杂志,2017,45(11):920-923.
[5]崔晶,杜昕,汤日波,等.心内科CHA2DS2-VASc评分对非瓣膜性心房颤动患者左心房血栓发生风险的评估作用及左心房血栓形成的危险因素[J].中国医药,2017,12(10):1441-1444.
[6]高鹏,方全,王佳丽,等.非瓣膜病心房颤动患者抗凝不足状况及原因分析[J].中华心血管病杂志,2013,41(11):931-934.
[7]孙艺红,胡大一.非瓣膜病心房颤动患者全球抗凝注册研究中国亚组基线数据分析[J].中华心血管病杂志,2014,42(10):846-850.
[8]黄华文,曾宪炳,周宏霞.267例老年非瓣膜性心房颤动住院患者的抗凝治疗状况分析[J].广东医科大学学报,2017,35(2):128-130.
[9]那开宪.应重视华法林治疗过程中的影响因素[J].中国临床医生杂志,2016,44(5):1-3,6.
[10]蔡洁玲,孙育民.非维生素K拮抗剂口服抗凝药在亚洲非瓣膜性心房颤动患者中的研究进展[J].中华心律失常学杂志,2017,21(4):302-304.
[11]Connolly J,Ezekowitz M,Yusuf S,et al.Newly identified events in the RE-LY trial[J].New Engl J Med,2010,363(19):1875-1876.
[12]Breithardt G,Baumgartner H,Berkowitz S,et al.Clinical cbaracteristics and outcomes with rivaroxaban vs.warfarin in patients with non-valvular atrial fibrillation but underlying native mitral and aortic valve disease participating in the ROCKET AFtrial[J].Eur Heart J,2014,35(47):3377-3385.
[13]王尹曼,钱菊英.新型口服抗凝药在老年人非瓣膜性心房颤动脑卒中预防中的应用[J].中华心律失常学杂志,2016,20(5):444-447.
[14]胡大一.心房颤动预防血栓栓塞的抗凝药物处方[J].中国医刊,2017,52(4):20-21.
[15]张涛,杨艳敏.心房颤动合并急性冠状动脉综合征患者的抗凝治疗[J].中华心律失常学杂志,2017,21(4):292-294.
[16]Olesen B,Lip Y,Lindhardsen J,et al.Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation:a net clinical benefit analysis using a“real world”nationwide cohort study[J].Thromb Haemost,2011,106(4):739-749.
[17]黄从新,黄德嘉,张澍,等.非瓣膜病心房颤动患者新型口服抗凝药的应用中国专家共识[J].中华心律失常学杂志,2014,18(5):321-32.
[18]郭红雨,段永珂,洪岩,等.达比加群酯与华法林用于非瓣膜性心房颤动患者抗凝的有效性与安全性比较[J].中国药房,2017,28(33):4461-4463.