心房颤动合并新发脑卒中患者口服抗凝治疗的现状和影响因素分析  被引量:2

Use of oral anticoagulants and related factors among new-onset acute ischemic stroke patients with nonvalvular atrial fibrillation:A report from the China Atrial Fibrillation Registry Study

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作  者:王靖荣[1,2] 杜昕 何柳[2] 董建增 张海滨[1] 郭金成[1] 马长生[2] Wang Jingrong;Du Xin;He Liu;Dong Jianzeng;Zhang Haibin;Guo Jincheng;Ma Changsheng(Department of Cardiology,Cardiovascular Center,Beijing Luhe Hospital,Capital Medical University,Beijing 101100,China;Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Centre for Cardiovascular Diseases,Beijing 100029,China)

机构地区:[1]首都医科大学附属北京潞河医院心血管内科,北京101100 [2]首都医科大学附属北京安贞医院心血管内科,国家心血管病临床医学研究中心,北京100029

出  处:《中华心血管病杂志》2022年第9期900-906,共7页Chinese Journal of Cardiology

基  金:国家重点研发计划课题(2018YFC1312501,2020YFC2004803);国家自然科学基金(82103904)。

摘  要:目的探讨心房颤动(房颤)合并新发脑卒中患者口服抗凝药物的应用现状和影响抗凝药物使用的相关因素。方法连续选取2011年8月至2018年12月参加中国房颤注册研究且在随访过程中新发急性非致死性缺血性脑卒中的非瓣膜性房颤患者,随访日期截止到2019年12月。根据患者脑卒中后是否服用抗凝药物分为抗凝组和非抗凝组,收集患者一般信息、合并疾病、用药史等基础临床资料。通过多因素logistic回归模型计算与卒中后抗凝药使用有关的因素的优势比(OR)分析房颤合并新发急性非致死性缺血性脑卒中人群抗凝药物治疗的应用现状和相关影响因素。结果本研究共纳入957例在随访过程中新发急性非致死性缺血性脑卒中的非瓣膜性房颤患者,卒中后3个月内口服抗凝药物(oral anticoagulant,OAC)治疗率39.4%(377/957)。多因素分析表明较高医保报销比例(OR:1.91,95%CI:1.28~2.86,P=0.002)、围卒中期房颤复发(OR:3.34,95%CI:2.34~4.76,P<0.001)、合并用药种类(1~2种OR:2.10,95%CI:1.36~3.23,P=0.001;≥3种OR:2.31,95%CI:1.37~3.91,P=0.002)是患者在卒中后3个月内应用口服抗凝治疗的保护性因素;相反,卒中前抗小板药物使用(OR:0.29,95%CI:0.20~0.43,P<0.001)和较高的HASBLED评分(OR:0.49,95%CI:0.40~0.60,P<0.001)则是应用口服抗凝治疗的独立危险因素。结论中国房颤合并急性脑卒中后3个月内患者口服抗凝治疗率较低。围卒中期的房颤复发、较高医疗保险报销比例、合并用药种类是患者卒中后3个月内应用口服抗凝治疗的保护性因素;卒中前抗血小板药物应用和较高的HASBLED评分则是影响患者卒中后3个月内应用口服抗凝治疗的独立危险因素。Objective This study aimed to investigate the oral anticoagulant(OAC)usage among new-onset acute ischemic stroke(AIS)patients with nonvalvular atrial fibrillation(NVAF)in China,and to explore the possible influencing factors of influent anticoagulant therapy in these patients.Methods The NVAF patients who experienced new-onset and non-fatal AIS from August 2011 to December 2018 in the China Atrial Fibrillation Registry(China-AF),were enrolled.The follow-up ended in December 2019.Information including patients′demographic characteristics,medical history,medication usage,which were collected before and after the index stroke,were analyzed.Patients were classified into OAC group or non-OAC group according to OAC usage within 3 months post stroke.Multivariate logistic regression analysis were conducted to calculate the odds ratios(ORs)of factors which might be associated with OAC usage within 3 months post stroke.Results A total of 957 new-onset AIS patients were enrolled,39.4%(377/957)patients were treated with OAC within 3 months after AIS.Covering by high-reimbursement-rate insurance(OR:1.91,95%CI:1.28-2.86,P=0.002),higher number of concomitant drugs(1-2 types OR:2.10,95%CI:1.36-3.23,P=0.001;≥3 types OR:2.31,95%CI:1.37-3.91,P=0.002)and 3-month-peri-stroke AF recurrence(OR:3.34,95%CI:2.34-4.76,P<0.001)were associated with OAC usage within 3 months post stroke,while higher HASBLED score(OR:0.49,95%CI:0.40-0.60,P<0.001)and pre-stroke antiplatelet usage(OR:0.29,95%CI:0.20-0.43,P<0.001)were related to no OAC usage within 3 months post stroke.Conclusions In China,the proportion of NVAF patients who initiated OAC therapy within 3 months after new-onset AIS is as low as about 39.4%.Factors related to the OAC usage within 3 months post stroke are 3-month-peri-stroke AF recurrence,number of concomitant drugs and patients with high-reimbursement-rate insurance coverage,but higher HASBLED score and pre-stroke antiplatelet usage are related to no OAC usage within 3 months post stroke.

关 键 词:心房颤动 脑卒中 抗凝 

分 类 号:R541.75[医药卫生—心血管疾病] R743.3[医药卫生—内科学]

 

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