医师对心房颤动患者处方低于推荐剂量非维生素K拮抗剂口服抗凝药经验及理由  

Physicians'experiences and reasons for prescribing off-label lower-dose non-vitamin K antagonist oral anticoagulants to patients with atrial fibrillation

作　　者：张天齐 刘俊鹏[2] 张亚同[1] 赵紫楠[1] 赵飞 孔应利 那一凡 曾敏 孙宁[2] 武程 王珺 杨杰孚[2] Zhang Tianqi;Liu Junpeng;Zhang Yatong;Zhao Zinan;Zhao Fei;Kong Yingli;Na Yifan;Zeng Min;Sun Ning;Wu Cheng;Wang Jun;Yang Jiefu(Department of Pharmacy,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pharmacy,Xingtai Central Hospital,Xingtai 054000,China)

机构地区：[1]北京医院药学部、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]北京医院心内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [3]邢台市中心医院药剂科,邢台054000

出　　处：《中华心律失常学杂志》2025年第1期55-60,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：中央高水平医院临床科研(BJ-2023-162)。

摘　　要：目的了解临床医师对非瓣膜性心房颤动(NVAF)患者处方低于推荐剂量非维生素K拮抗剂口服抗凝药(NOAC)的经验及理由。方法本研究为横断面问卷调查研究。采用自行设计的调查问卷于2023年11月至2024年1月对北京地区19家不同级别医院的270名医师进行问卷调查,内容包括医师对NVAF患者处方低于推荐剂量NOAC的经验和理由。对该两项结果进行描述性统计分析,并从医院等级、职称等级、临床专业的角度进行组间比较。结果99.3%(268/270)的医师处方低于推荐剂量NOAC,主要方案是利伐沙班10 mg qd(每日1次,87.8%,237/270)、达比加群酯110 mg qd(48.5%,131/270)和艾多沙班15 mg qd(46.7%,126/270)。高级职称医师较非高级职称医师处方达比加群酯110 mg qd[56.1%(74/132)对41.3%(57/138),P=0.015]和艾多沙班15 mg qd[53.8%(71/132)对39.9%(55/138),P=0.022]的占比更高,心内科医师较非心内科医师处方艾多沙班15 mg qd[52.6%(80/152)对39.0%(46/118),P=0.028]的占比更高。主要理由是降低出血风险(84.4%,228/270)和高龄(80.0%,216/270)。三甲医院医师更关注高龄[86%(135/157)对71.7%(81/113),P=0.004]和虚弱或衰弱[38.9%(61/157)对19.5%(22/113),P=0.001],而非三甲医院医师更关注用药的便利性[23.9%(27/113)对13.4%(21/157),P=0.026]。高级职称医师更注重体重过低[62.9%(83/132)对47.1%(65/138),P=0.009]与跌倒史[17.4%(23/132)对5.8%(8/138),P=0.003]。心内科医师则更关注高龄[88.8%(135/152)对68.6%(81/118),P<0.001]和体重过低[71.7%(109/152)对33.1%(39/118),P<0.001]。结论医师给NVAF患者处方NOAC时低于推荐剂量的情况非常普遍,主要顾虑是出血风险和高龄,资深医师对NOAC剂量更为谨慎。ObjectiveTo learn the physicians'experiences and reasons for prescribing off-label lower-dose non-vitamin K antagonist oral anticoagulants(NOAC)to patient with non-valvular atrial fibrillation(NVAF).MethodsThis study was a cross-sectional questionnaire survey.A self-designed questionnaire with questions about the experiences and reasons to prescribe off-label lower-dose NOAC was distributed to 270 physicians of 19 hospitals in Beijing,within all three levels included,from November 2023 to January 2024.Descriptive statistical analysis was conducted about the experiences or reasons for prescribing off-label lower-dose NOAC to NVAF patient,with the subgroup comparisons for them from the aspects of hospital level,professional ranking and clinical specialties.ResultsIn total,99.3%(268/270)physicians had prescribed off-label lower-dose NOAC.The most commonly-used off-label lower-dose NOAC regimens were rivaroxaban 10 mg qd(once a day,87.8%,237/270),dabigatran etexilate 110 mg qd(48.5%,131/270),edoxaban 15 mg qd(46.7%,126/270).More senior physicians prescribed dabigatran etexilate 110 mg qd[56.1%(74/132)vs.41.3%(57/138),P=0.015]and edoxaban 15 mg qd[53.8%(71/132)vs.39.9%(55/138),P=0.022]than those without senior professional titles,and more cardiologist prescribed edoxaban 15 mg qd[52.6%(80/152)vs.39.0%(46/118),P=0.028]than non-cardiologist.The main reasons were"to reduce the risk of bleeding"(84.4%,228/270)and"advanced age"(80.0%,216/270).Comparing with their counterparts,physicians from tertiary hospital gave priority to"advanced age"[86%(135/157)vs.71.7%(81/113),P=0.004]and"frailty"[38.9%(61/157)vs.19.5%(22/113),P=0.001],and pay less attention to"convenience of medication"[13.4%(21/157)vs.23.9%(27/113),P=0.026];senior physicians gave priority to"low body weight"[62.9%(83/132)vs.47.1%(65/138),P=0.009]and"history of falls"[17.4%(23/132)vs.5.8%(8/138),P=0.003];cardiologist gave priority to"advanced age"[88.8%(135/152)vs.68.6%(81/118),P<0.001]and"low body weight"[71.7%(109/152)vs.33.1%(39/118),P<0.001].ConclusionIt is ph

关 键 词：心房颤动 处方行为 抗凝 非维生素K拮抗剂口服抗凝药 剂量 脑卒中 

分 类 号：R54[医药卫生—心血管疾病]