高龄稳定性冠心病合并非瓣膜性心房颤动患者抗栓治疗现状研究  

Antithrombotic therapy in elderly patients with stable coronary heart disease complicated with nonvalvular atrial fibrillation

作　　者：王征[1] 闫盈盈[2] 朱昀[1] 武东[1] 郭英[1] 张帆[1] WANG Zheng;YAN Ying-ying;ZHU Yun;WU Dong;GUO Ying;ZHANG Fan(Department of Gerontology,Peking University Third Hospital,Beijing 100191,China;Department of Pharmacy,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院老年内科,北京100191 [2]北京大学第三医院药剂科,北京100191

出　　处：《临床军医杂志》2020年第3期246-249,共4页Clinical Journal of Medical Officers

基　　金：吴阶平医学基金会(320.6750.17556)。

摘　　要：目的研究稳定性冠心病合并非瓣膜性心房颤动的高龄患者抗栓治疗的现状。方法回顾性分析自2016年10月至2019年10月在北京大学第三医院老年内科住院治疗的稳定性冠心病合并非瓣膜性心房颤动患者的临床资料。对患者基本信息、结局等进行描述性分析。根据患者是否接受抗凝或抗血小板治疗将其分为接受抗凝或抗血小板治疗组(n=236)与未接受抗凝或抗血小板治疗组(n=18),再将接受抗凝或抗血小板治疗的患者根据治疗方案分为单药抗血小板治疗(SAPT)组(n=138)、口服抗凝药物治疗(OAC)组(n=60)及抗凝联合单药抗血小板治疗(OAC+SAPT)组(n=38)。根据患者是否接受抗凝治疗将其分为抗凝组(n=98)与未抗凝组(n=156)。探讨患者不同抗栓方案与其治疗结局的相关性。结果本研究共纳入254例患者,平均年龄(84.94±5.89)岁,CHADS2评分、CHA2DS2-VASc评分、HAS-BLED评分分别为(3.54±1.38)分、(5.61±1.57)分、(3.08±0.89)分。所有入组患者中死亡40例(15.7%),栓塞56例(22.0%),出血54例(21.3%)。接受抗凝或抗血小板治疗组患者的死亡事件、栓塞事件的发生率均低于未接受抗凝或抗血小板治疗组,差异有统计学意义(P<0.05)。抗凝组死亡事件、栓塞事件的发生率均低于未抗凝组,差异有统计学意义(P<0.05)。OAC+SAPT组与SAPT组患者死亡事件发生率比较,差异有统计学意义(P<0.05);而OAC+SAPT组与OAC组患者死亡事件发生率比较,差异无统计学意义(P>0.05);OAC+SAPT组栓塞事件发生率低于SAPT组、OAC组,差异有统计学意义(P<0.05)。结论高龄稳定性冠心病合并非瓣膜性房颤患者接受抗凝治疗的比例较低,抗凝药物应用仍不充分,抗血小板单药治疗与患者死亡及栓塞的不良结局可能相关。Objective To investigate the status of antithrombotic therapy in elderly patients with stable coronary heart disease complicated with nonvalvular atrial fibrillation(NVAF).Methods A retrospective study was performed on patients diagnosed as stable coronary heart disease with NVAF who were admitted from October 2016 to October 2019.Descriptive analysis was conducted on the basic information and the outcome of patients.According to whether they received anticoagulation or antiplatelet therapy or not,patients were divided into the anticoagulation or antiplatelet therapy group(n=236)and non anticoagulation or antiplatelet therapy group(n=18).The patients who received anticoagulant or antiplatelet therapy were divided into three groups according to the treatment plan:single drug antiplatelet therapy(SAPT)group(n=138),oral anticoagulant therapy(OAC)group(n=60)and anticoagulant combined with single drug antiplatelet therapy(OAC+SAPT)group(n=38).The patients were divided into the anticoagulant group(n=98)and non anticoagulant group(n=156)according to whether they received anticoagulant treatment or not.The relationship between different antithrombotic regimens and the outcome of patients was analyzed.Results A total of 254 patients were included in this study,with an average age of(84.94±5.89)years.The CHADS2 score,CHA2DS2-VASc score and HAS-BLED score were(3.54±1.38)points,(5.61±1.57)points and(3.08±0.89)points,respectively.Among all enrolled patients,there were 40 cases deaths(15.7%),56 cases(22.0%)of embolism,and 54 cases(21.3%)of hemorrhage.The incidence of death and embolization events in the group receiving anticoagulation or antiplatelet therapy was lower than that in the group without anticoagulation or antiplatelet therapy,with statistically significant differences(P<0.05).The incidence of death and embolization events in the anticoagulant group was lower than that in the non-anticoagulant group(P<0.05).The incidence of death events between OAC+SAPT group and SAPT group was statistically significant(P<0.05).

关 键 词：冠心病 非瓣膜性心房颤动 抗栓 抗血小板 抗凝 

分 类 号：R541.4[医药卫生—心血管疾病] R541.75[医药卫生—内科学]