75岁以上老年非瓣膜病性心房颤动患者抗凝治疗的临床分析  

Clinical analysis of anticoagulation therapy in patients aged 75 years or older with non-valvular atrial fibrillation

作　　者：禹越 杨伟[1] 罗丹 孟恬宇 郑文玲 张玮[1] 任延平[1] 苏显明[1] Yu Yue;Yang Wei;Luo Dan;Meng Tianyu;Zheng Wenling;Zhang Wei;Ren Yanping;Su Xianming(Department of Geriatric Cardiology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,Shaanxi Province,China)

机构地区：[1]西安交通大学第一附属医院老年心血管内科,710061

出　　处：《中华老年心脑血管病杂志》2023年第6期593-596,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：陕西省自然科学基金项目(2016JM8082)。

摘　　要：目的了解老年非瓣膜病性心房颤动(房颤)患者的抗凝治疗现状及影响的因素。方法纳入2020年1月至2021年9月于我院不同科室住院的75岁以上非瓣膜性房颤患者382例,其中心血管内科217例分布最多,根据出院时抗凝方案不同分为抗凝组260例及未抗凝组122例。对患者进行1年随访并记录出血、缺血性脑卒中及死亡事件的发生情况。分析影响老年房颤患者是否抗凝的相关因素。结果抗凝组吸烟、饮酒、冠心病、出血史、肿瘤、抗血小板药物比例及HAS-BLED评分明显低于未抗凝组(P<0.05,P<0.01)。二元logistic回归分析显示,出血史(OR=0.320,95%CI:0.120~0.853,P=0.023)、肿瘤(OR=0.348,95%CI:0.139~0.869,P=0.024)、既往口服抗血小板药物(OR=0.095,95%CI:0.049~0.185,P=0.000)是影响老年房颤患者抗凝药物选择的相关因素。结论出血史、肿瘤及既往口服抗血小板药物史可影响房颤患者出院时的选择。Objective To investigate the current status of anticoagulation therapy and the related influencing factors in elderly patients with non-valvular atrial fibrillation(NVAF).Methods A total of 382 elderly NVAF patients aged 75 years or older who were hospitalized in different departments of our hospital from January 2020 to September 2021,with 217 cases in cardiovascular department having the majority,were recruited in this study.According to the anticoagulation regimens at discharge,they were divided into anticoagulation group(n=260)and non-anticoagulation group(n=122).All of them were followed up for 1 year,and the occurrences of bleeding,ischemic stroke and death events were recorded.The factors affecting anticoagulation were also analyzed in these elderly NVAF patients.Results The patients from the anticoagulation group had smaller proportions of smoking,alcohol consumption,coronary heart disease,history of bleeding,tumor,and use of antiplatelet drugs,and lower HAS-BLED bleeding risk score when compared with the patients of the non-anticoagulation group(P<0.05,P<0.01).Bleeding history(OR=0.320,95%CI:0.120-0.853,P=0.023),tumor(OR=0.348,95%CI:0.139-0.869,P=0.024)and previous antiplatelet drug administration(OR=0.095,95%CI:0.049-0.185,P=0.000)were relevant factors influencing anticoagulant selection in the elderly AF patients.Conclusion His-tory of bleeding,tumor,and previous history of antiplatelet medication administration can influence the choice of AF patients at discharge.

关 键 词：心房颤动 抗凝药 血小板聚集抑制剂 数据相关性 

分 类 号：R541.75[医药卫生—心血管疾病]