老年非瓣膜性心房颤动病人中断抗凝治疗对远期预后的影响  

Effects of discontinuing anticoagulation therapy on long-term prognosis in elderly patients with non-valvular atrial fibrillation

作　　者：江瑞 高悦 杜为 杨浩[3] 董庆山 李先进[3] 李世杰[3] 韩冰 JIANG Rui;GAO Yue;DU Wei;YANG Hao;DONG Qingshan;LI Xianjin;LI Shijie;HAN Bing(Xuzhou Clinical College of Xuzhou Medical University,Xuzhou 221009,China;Graduate School of Bengbu Medical University,Bengbu 233000,China;Department of Cardiology,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州医科大学徐州临床学院,江苏省徐州市221009 [2]蚌埠医科大学研究生院,安徽省蚌埠市233000 [3]徐州市中心医院心血管内科,江苏省徐州市221000

出　　处：《实用老年医学》2025年第3期254-257,262,共5页Practical Geriatrics

基　　金：徐州市科技项目(KC21155);徐州市领军人才培养项目(XWRCHT20210032)。

摘　　要：目的通过长期随访评估老年心房颤动(房颤)病人中断使用口服抗凝药(OAC)对临床结局的影响。方法将2018年7月至2020年12月在徐州市中心医院门诊就诊或住院治疗的已经接受处方OAC的年龄≥75岁老年非瓣膜性房颤(NVAF)病人纳入此研究,收集病人人口学及临床资料,通过门诊及电话进行长期随访。复合观察终点为脑卒中或全因死亡。采用多因素Cox回归分析影响临床预后的相关因素。结果本研究总共纳入了560例病人,中位年龄为80(78,84)岁。随访截止时间为2022年12月。在平均33个月的随访期内,262例(46.8%)中断了抗凝治疗。相较于持续接受抗凝治疗的病人,中断抗凝组在随访期内终点事件发生率显著升高(46.9%比25.2%,P<0.01)。多因素Cox回归分析显示,中断抗凝治疗是卒中或全因死亡的独立危险因素(HR=1.74,95%CI:1.29~2.34,P<0.01)。结论在已接受抗凝治疗的老年NVAF病人中,近半数在长期随访期间中断了OAC使用,抗凝的中断与临床长期预后不良存在相关性。Objective To evaluate the relationship between discontinuation of oral anticoagulants(OAC)use and clinical outcomes in the elderly patients with atrial fibrillation through long-term follow-up.Methods The elderly patients aged≥75 years with non-valvular atrial fibrillation(NVAF)who had been prescribed OAC at Xuzhou Central Hospital from July 2018 to December 2020 were enrolled in this study.Demographic and clinical data of the patients were collected,and long-term follow-up was conducted through outpatient clinics and telephone calls.The composite outcome was stroke or all-cause death.Multivariate Cox regression model was used to analyze the relevant factors of clinical prognosis.Results A total of 560 patients with a median age of 80(78,84)years were enrolled in the study.During a mean follow-up period of 33 months,262 patients(46.8%)discontinued anticoagulant therapy.The discontinuation group had a significantly higher incidence of endpoint events during the follow-up period than the continuation group(46.9%vs.25.2%,P<0.01).Multivariate Cox analysis showed that discontinuation of anticoagulant therapy was an independent risk factor for endpoint events(HR=1.74,95%CI:1.29-2.34,P<0.01).Conclusions Nearly half of elderly NVAF patients who had received anticoagulation therapy discontinued OAC during long-term follow-up,and discontinuation of anticoagulation shows effects on poor clinical long-term prognosis.

关 键 词：非瓣膜性房颤 老年人 口服抗凝剂 治疗中断 临床预后 

分 类 号：R541.75[医药卫生—心血管疾病]