急性缺血性卒中合并非瓣膜性心房颤动患者出院时口服抗凝药使用情况及其影响因素分析  

Analysis of anticoagulant use and influencing factors in acute ischemic stroke patients with nonvalvular atrial fibrillation

作　　者：邱雪 薛素芳[1] 宋海庆[1] QiuXue;Xue Sufang;Song Haiqing(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]北京市朝阳区双桥医院神经内科,100024

出　　处：《中国脑血管病杂志》2021年第11期753-764,共12页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究重点专项(2016YFC1300600);首都卫生发展科研专项(首发2020-2-2014)。

摘　　要：目的分析急性缺血性卒中合并非瓣膜性心房颤动(NVAF)患者出院时口服抗凝药物使用情况及其影响因素。方法连续回顾性纳入急性缺血性卒中合并心房颤动患者登记研究(NCT04080830)中2016年1月至2020年12月首都医科大学宣武医院神经内科收治的急性缺血性卒中合并NVAF的住院患者702例,CHA 2DS 2-VASc评分[NVAF卒中风险评分:C为充血性心力衰竭,H为高血压,A 2为年龄≥75岁计2分,D为糖尿病,S 2为卒中或短暂性脑缺血发作计2分,V为血管性疾病,A为年龄65~74岁,Sc为性别(女性)]≥2分,收集患者的一般情况(性别、年龄、体质量指数)、既往史[下肢血管狭窄或闭塞、急性期下肢静脉血栓或肺栓塞、心功能不全、脑梗死和(或)短暂性脑缺血发作、肝病史和(或)肝功能异常]、心脑血管疾病危险因素(冠心病、高血压病、高脂血症、糖尿病、吸烟、饮酒)、相关实验室检查(血红蛋白≤90 g/L、血肌酐≥200μmol/L等)、量表评分[NVAF卒中风险评分、出血风险评分、美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分]、出院时抗栓药物使用情况以及有无大面积脑梗死、梗死后出血转化、共存颅内外血管狭窄、急性期非主要出血、急性期大出血、医疗保险报销范围等。依据年份分层,即2016、2017、2018、2019、2020年,对各年份急性缺血性卒中合并NVAF患者出院时抗栓药物使用占比及趋势进行比较。根据新型口服抗凝药(NOACs)纳入医疗保险系统分为医保前(2016—2017年)组与医保后(2018—2020年)组,对相关数据进行对比分析。分析急性缺血性卒中合并NVAF患者出院时抗凝药物使用情况及其变化趋势,并分析NOCAs进入医疗保险系统后,对影响出院时口服抗凝药物使用情况的相关因素。比较不同抗凝药物出血事件发生率。医疗保险范围包括农村合作医疗报销、城镇医疗保险报销和职工医疗保险报Objective To analyze the trend of anticoagulation usage and influencing factors in acute ischemic stroke(AIS)patients with nonvalvular atrial fibrillation patients(NVAF).Methods A total of 702 AIS patients with NVAF admitted to the Department of Neurology of Xuanwu Hospital,Capital Medical University from January 2016 to December 2020 were enrolled retrospectively in the registration study of acute ischemic stroke with atrial fibrillation(NCT04080830).Patients had CHA_(2)DS_(2)-VASc(NVAF stroke risk score:C for congestive heart failure,H for hypertension,A_(2) for age≥75 years old as 2 points,D for diabetes,S_(2) for stroke or transient ischemic attack as 2 points,V for vascular disease,A for age 65-74 years old,Sc for gender[female])≥2 points.Patient′s general condition(gender,age,body mass index),past medical history(lower limb vascular stenosis or occlusion,acute lower extremity venous thrombosis or pulmonary embolism,cardiac insufficiency,cerebral infarction and[or]transient ischemic attack,history of liver disease and[or]abnormal liver function),risk factors for cardiovascular disease(coronary heart disease,hypertension,hyperlipidemia,diabetes,smoking and drinking),relevant laboratory tests(hemoglobin≤90 g/L,serum creatinine≥200μmol/L,etc.),scale scores(NVAF stroke risk score,bleeding risk score,the National Institutes of Health Stroke Scale[NIHSS]score,modified Rankin scale[mRS]score),the use of antithrombotic drugs at discharge,large cerebral infarction,post-infarction hemorrhagic transformation,co-existing intracranial and extracranial vascular stenosis,non-major acute hemorrhage,acute massive hemorrhage,reimbursement scope of medical insurance,etc.The proportion and trend of antithrombotic drug use at discharge in AIS patients with NVAF were compared according to year stratification,i.e.,2016,2017,2018,2019 and 2020.According to the inclusion time of new oral anticoagulants(NOACs)into the medical insurance system,they were divided into pre-medical insurance group(2016—2017)and post-medical i

关 键 词：急性缺血性卒中 心房颤动 抗凝治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]