90岁及以上住院心房颤动患者抗凝现状及院内缺血与出血事件分析  

Analysis of anticoagulant status and in-hospital ischemic and bleeding events in atrial fibrillation patients aged 90 years and over

作　　者：席少枝 郁水华[1] 何水波[1] 李向楠[1] 孟锐[1] 龚祚娟[1] 高云磊[1] 易忠[1] Xi Shaozhi;Yu Shuihua;He Shuibo;Li Xiangnan;Meng Rui;Gong Zuojuan;Gao Yunlei;Yi Zhong(Department of Geriatrics(1),Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院老年医学一科,北京100049

出　　处：《中华老年医学杂志》2020年第10期1178-1181,共4页Chinese Journal of Geriatrics

摘　　要：目的了解90岁及以上住院心房颤动(AF)患者住院期间抗凝现状及分析院内缺血与出血事件发生情况。方法回顾性收集2014年6月至2019年8月我院住院的90岁及以上非瓣膜性心房颤动(NVAF)患者的临床资料、抗栓治疗策略及院内缺血性脑卒中及院内主要出血情况,根据房颤血栓危险度(CHA2DS2-VASc)评分分为2,3,≥4分3组,评估3组中不同抗栓治疗策略及院内缺血性脑卒中情况,同时根据出血风险(HAS-BLED)评分分为出血高危组(≥3分)及非出血高危组(≤2分),评估两组中不同抗栓治疗策略及院内主要出血情况。结果在223例90岁及以上NVAF患者中,住院期间给予抗凝治疗比例42.6%,仅给予抗血小板治疗比例25.6%,未给予任何抗栓治疗比例31.8%;随着CHA2DS2-VASc评分增加,住院期间未给予任何抗栓治疗的比例呈逐渐下降趋势(47.4%和42.9%和26.4%),但3组间不同抗栓治疗策略差异无统计学意义(P=0.06),院内缺血性脑卒中发生率差异亦无统计学意义(10.5%和12.2%和15.5%,P=0.75);与非出血高危组相比,出血高危组患者住院期间给予抗凝治疗比例稍高(47.2%和38.3%),未给予任何抗栓治疗的患者稍低(28.7%和34.7%),两组间不同抗栓治疗策略差异无统计学意义(P=0.39),院内主要出血发生率差异无统计学意义(13.0%和10.2%,P=0.51),合并感染、呼吸衰竭患者,院内主要出血发生率升高(16.8%和6.4%,P=0.02;21.3%和8.0%,P=0.01)。结论 90岁及以上NVAF患者住院期间抗凝比率偏低,应规范化抗凝治疗;同时,在评估其出血风险时,除HAS-BLED评分外,应考虑是否合并感染、呼吸衰竭等可能增加出血风险的疾病。Objective To investigate the current status of anticoagulant therapy and the incidence of ischemic and bleeding eventvs in hospitalized patients aged 90 years and over with non-valvular atrial fibrillation(NVAF).Methods We retrospectively collected clinical data,antithrombotic treatment strategies,in-hospital ischemic stroke and bleeding events from NVAF patients(≥90 years)who were admitted to our hospital from June 2014 to August 2018.Based on the C H A:.DS2-V ASc score(2,3,and≥4 respectively).patients were divided into three ischemic risk groupvS,and antithrombotic treatment strategies and in-hospital ischemic stroke events were compared between the three groups.Alternatively,patients were divided into the high bleeding risk group(HAS-BLED score≥3,)and the non-high bleeding risk group(HAS-BLED score≤2).and antithrombic treatment strategies and the major bleeding events were compared between the two groups.Results Among the 223 hospitalized NVAF patient.s aged 90 years and over.42.6%of them received anticoagulant treatment,25.6%received antiplatelet drugs,and 31.8%received non-antithrombotic treatment.With the increase of the CHA-DS2-VASc score,there was a trend of declined rates of nonantithrombotic treatment among the three ischemic risk groups(47.4%,42.9%,26.4%,P=0.06),and the rates of in-hospital ischemic stroke were similar among groups(10.5%,12.2%,15.5%,P=0.75).Moreover,compared with the non-high bleeding risk group,patients in the high bleeding risk group more frequently received anticoagulant treatment(47.2%vs.38.3%)and less frequently received non-antithrombotic therapy(28.7%vs.34.7%).There was no significant difference in antithrombotic treatment strategies(P=0.39)or rate of in-hospital major bleeding events(13.0%vs.10.2%,P=0.51).However.the rate of in-hospital major bleeding events was significantly higher in those with concurrent infections(16.8%vs.6.4%,P=0.02)or respiratory failure(21.3%8.0%,P=0.01).Conclusions The rate of anticoagulant use in NVAF patients aged 90 years and over is too low

关 键 词：心房颤动 抗凝药 卒中 出血 

分 类 号：R541.75[医药卫生—心血管疾病]