老年非瓣膜病性心房纤颤患者抗血栓治疗现状分析

Current situation of antithrombotic therapy in elderly patients with nonvalvular atrial fibrillation

【摘要】目的分析空军总医院老年非瓣膜病性心房纤颤(NVAF)患者抗血栓药物治疗现状及未抗凝治疗的原因。方法调查老年NVAF患者109例,对其病因、血栓栓塞危险因素、抗血栓药物应用情况及未应用华法林抗凝治疗原因进行分析。应用CHADS卒中风险评分表对NVAF患者进行血栓栓塞危险评估。结果91.6%患者接受了抗血栓治疗。符合抗凝治疗指征患者68例,仅38.2%接受了华法林治疗,57.4%进行了抗血小板治疗阿司匹林剂量为(87±15)mg/d,4.4%未进行任何抗血栓治疗。而其中NVAF呈阵发性者仅5.0%应用了华法林抗凝治疗。未抗凝治疗者54例,其中存在抗凝禁忌证12例(15.0%);严重出血而停用1例(1.3%),不能凝血监测2例(2.5%);担心出血拒绝8例(10.0%);阵发性心房纤颤未抗凝治疗20例(25.0%);冠脉支架术后双重抗血小板治疗而未抗凝治疗3例(3.75%);原因不明9例(11.3%)。结论老年NVAF患者抗血栓治疗中华法林应用率低,而且阵发性心房纤颤的华法林应用率更低,抗血小板治疗中阿司匹林剂量不足。

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【Abstract】Objective To analyze the current situation of antithrombotic therapy in elderly patients with nonvalvular atrial fibrillation(NVAF)and the reasons for absence of anticoagulant therapy. Methods One hundred and nine elderly patients (≥60 years old) with NVAF were enrolled. Their etiological factors,thromboembolism risk factors,antithrombotic medications and reasons for absence of anticoagulant therapy were analyzed. The thromboembolism risk was evaluated through CHADS stroke risk scoring system. Results Ninety-one point six percentage NVAF patients received antithrombotic therapy. There were 68 patients who were consistent with the indications of anticoagulant therapy. Only 38.2% received administration of warfarin;57.4% were submitted to antiplatelet medication,aspirin (87±15)mg/d;4.4% denied antithrombotic medication. Only 5.0% patients with paroxysmal atrial fibrillation received anticoagulant therapy with warfarin. There were 54 patients who did not receive anticoagulant therapy,of which,12 (15.0%) were due to anticoagulant contraindication;1 (1.3%) due to severe hemorrhage;2 (2.5%) due to unavailable coagulating monitoring;8 (10.0%) due to worrying about hemorrhage;20 (25.0%) due to paroxysmal atrial fibrillation;3 (3.75%) due to previous antiplatelet therapy after coronary stent implantation;9 (11.3%) due to unknown reason. Conclusion The usage rate of warfarin in antithrombotic therapy for elderly NVAF patients is low,and even lower in patients with paroxysmal atrial fibrillation. The dosage of aspirin for anticoagulant therapy seems not enough.