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  

Anticoagulant therapy for the elderly hospitalized patients with nonvalvular atrial fibrillation: 267 cases

作　　者：黄华文[1] 曾宪炳 周宏霞 HUANG Hua-wen ZENG Xian-bing ZHOU Hong-xia(Department of Gardiology of Lianjiang People＇s Hospital, Lianjiang 524400, China Lianjiang Hospital of Traditional Chinese Medicine, Lianjiang 524400, China)

机构地区：[1]广东省廉江市人民医院心内科,广东廉江524400 [2]广东省廉江市中医院,广东廉江524400

出　　处：《广东医科大学学报》2017年第2期128-130,共3页Journal of Guangdong Medical University

摘　　要：目的分析老年非瓣膜性心房颤动(AF)住院患者抗凝治疗状况,以期更好指导临床抗凝治疗,减少房颤导致的卒中事件。方法收集267例因患非瓣膜性AF住院的老年患者的基础临床资料和用药情况(抗凝治疗方案及监测情况),分析患者临床特点与抗凝情况的关系。采用CHA2 SD2-VASc评分标准,出血评分采用HAS-BLED评分标准,对入选患者进行出血、卒中风险评估,分析两者与抗栓方案的关系。随访1 a,观察患者卒中和出血事件的发生情况。结果本组267例中229例有抗凝指征,仅69例行抗凝治疗,其中68例用华法林抗凝治疗[住院期间INR达标者(2.0~3.0)10例]。年龄≥75岁以及合并有心力衰竭、冠心病、既往有脑卒中史或出血史为影响抗凝治疗的因素。267例患者的平均CHA2DS2-VASc得分为(3.60±1.87)分,平均HAS-BLED得分为(1.52±0.89)分。CHA2DS2-VASc分值为0、1、2的抗凝治疗率分别为29.6%(8/27)、34.3%(11/32)和18.9%(50/246)。HASBLED分值<3和≥3的抗凝治疗率分别为27.4%(69/251)和7.4%(4/54)。出院后随访结果显示,行抗凝治疗患者的卒中和出血事件的发生率与未行抗凝治疗患者的差异均无统计学意义(P>0.05)。结论老年非瓣膜性AF住院患者需行抗凝治疗,但其目前住院期间的抗凝治疗率低,华法林治疗的INR达标率低。Objective To analyze the application of anticoagulant therapy in the elderly patients with nonvalvular atrial fibrillation so as to better guide clinical anticoagulant therapy and reduce the incidence of stroke caused by atrial fibrillation. Methods The basic clinical data and medication information （anticoagulant therapeutic regimen and monitoring） of the elderly patients with nonvalvular atrial fibrillation were collected, and the relationship between the clinical characteristics of the patients and anticoagulation was analyzed. CHA2DS2-VASc score and HAS-BLEDS score were used to conduct the bleeding and stroke risk analysis, and their relationship with anticoagulation regimen was analyzed. After a follow-up of 1 a, the incidence of stroke and bleeding in the patients were observed. Results Of 267 cases, there were 229 cases with anticoa- gulation indications, and only 69 cases received anticoagulant therapy and 68 of them received routine anticoagulation with warfarin. An age of ≥75 years, a complication with heart failure or coronary disease and plast history of stroke or bleeding were the factors affecting the anticoagulant therapy. The average CHA2DS2 - VASc score was （3.60± 1.87） points and the average HAS-BLED score was （1.52±0.89） points in the patients. The patients with the CHA2DS2-VASc score of 0, 1 and 2 had the cure rate of anticoagulation therapy of 29.6% （8/27）, 34.3% （11/32） and 18.9% （50/246）, respectively. The patients with the HASBLED score of 〈3 and ≥ 3 had the cure rate of anticoagulation therapy of 27.4% （69/251） and 7.4% （4/54）, respectively. The follow-up results after hospital discharge showed that, there was no statistical difference in the incidence of stroke and bleeding events between the patients receiving anticoagulant therapy and those not （P〉0.05）. Conclusion The elderly patients with atrial fibrillation need anticoagulant therapy, but the cure rate of anticoagulant therapy during the hospitalization is low, and the rate oflNR complia

关 键 词：非瓣膜性心房颤动 抗凝治疗 

分 类 号：R541.75[医药卫生—心血管疾病]