机构地区:[1]福建医科大学附属第一医院心血管内科,福建福州350005 [2]泉州市第一医院心脏彩超室
出 处:《中华高血压杂志》2024年第1期71-77,共7页Chinese Journal of Hypertension
摘 要:目的回顾性分析2013—2020年非瓣膜性心房颤动(NVAF)住院患者抗凝策略的变化情况。方法入选2013年1月至2020年12月从福建医科大学附属第一医院出院的NVAF患者4135例,每2年为一个时间段分组,把患者分为4组进行分析(2013—2014年组1047例,2015—2016年组1036例,2017—2018年组1042例,2019—2020年组1010例)。以非瓣膜病性心房颤动脑卒中危险的评分(CHA2DS2-VASc)、心房颤动抗凝治疗出血评分系统(HAS-BLED)作为危险分层依据,分析NVAF患者抗凝治疗率,以及华法林与新型口服抗凝药(NOACs)使用情况。结果脑卒中高危患者(CHA2DS2-VASc评分≥2分男性,≥3女性患者),2013—2014、2015—2016、2017—2018、2019—2020年组抗凝比例分别为30.23%、38.04%、62.69%和76.67%,抗凝比例随时间推移而增加(χ_(趋势)^(2)=392.549,P<0.001)。在HAS-BLED评分≤2分患者中,2013—2014、2015—2016、2017—2018、2019—2020年组的抗凝比例分别为33.70%、41.09%、62.19%和65.73%;HAS-BLED评分≥3分患者,各组抗凝比例分别为20.00%、30.23%、40.54%和75.29%。高危和低危出血患者抗凝比例都随时间推移而增加。2013—2014、2015—2016、2017—2018、2019—2020年组采用华法林抗凝的比例分别为33.05%、36.97%、15.36%和4.16%,采用NOACs抗凝的比例分别为0、3.67%、46.07%和62.38%。服用华法林的患者国际标准化比值(INR)在治疗目标范围内(2~3)的时间百分比(TTR)中位数为38.0%(20.0%,50.0%),TTR在65%以上的患者只有11.55%。结论NVAF患者的抗凝比例随时间推移逐渐增加,但与指南建议有一定的差距;服用华法林患者门诊监测INR的达标率低;服用华法林抗凝治疗率在下降,NOACs已经开始部分替代华法林抗凝治疗。Objective To retrospectively analyze the change of anticoagulant therapy in hospitalized patients with nonvalvular atrial fibrillation(NVAF)from 2013 to 2020.Methods Four thousand one hundred and thirty-five patients with NVAF discharged from the First Hospital of Fujian Medical University from January 2013 to December 2020 were enrolled,and the patients were divided into 4 groups according to the time period of every 2 years(1047 patients in the 2013-2014 group,1036 patients in the 2015-2016 group,1042 patients in the 2017-2018 group,and 1010 patients in the 2019-2020 group).The CHA2DS2-VASc[congestive heart failure,hypertension,age≥75(doubled),diabetes mellitus,stroke(doubled),vascular disease,age 65-74 and sex category(female)]score and HAS-BLED(hypertension,abnormal renal/liver function,stroke,bleeding history or predisposition,labile international normalized ratio,elderly,drugs/alcohol concomitantly)score were involved in the risk stratification.The rates of anticoagulation,warfarin and new oral anticoagulants(NOACs)use in each group were analyzed.Results In patients at high risk of stroke(men with CHA2DS2-VASc score≥2 and women with CHA2DS2-VASc score≥3),the rates of anticoagulation use were 30.23%,38.04%,62.69%,and 76.67% respectively in the year of 2013-2014,2015-2016,2017-2018,2019-2020,showing an increasing trend over time(χ_(for trend)^(2)=392.549,P<0.001).The rates of anticoagulation use in the year of 2013-2014,2015-2016,2017-2018,2019-2020 were 33.70%,41.09%,62.19%,and 65.73%,respectively in patients with HAS-BLED score of≤2,and which were 20.00%,30.23%,40.54% and 75.29% respectively in patients with HAS-BLED score of≥3.The rates of anticoagulation use showed an increasing trend over time in patients with high and low risk of bleeding.The proportions of using warfarin for anticoagulation in 2013-2014,2015-2016,2017-2018,2019-2020 were 33.05%,36.97%,15.36%,and 4.16%,respectively,and the proportions of using NOACs for anticoagulation were 0,3.67%,46.07%,and 62.38%,respectively.The median ti
分 类 号:R541.75[医药卫生—心血管疾病]
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