重庆市二、三级医院老年非瓣膜性房颤患者抗栓现状调查

夏圳; 陆凯; 陈娴雅; 谢思媛; 胡华超; 肖骅

doi:10.16016/j.1000-5404.202008168

您当前的位置：

首页 >

文章列表页 >

重庆市二、三级医院老年非瓣膜性房颤患者抗栓现状调查

公共卫生与预防医学 | 更新时间：2026-01-09

- 重庆市二、三级医院老年非瓣膜性房颤患者抗栓现状调查
- Anticoagulation status of elderly patients with non-valvular atrial fibrillation in secondary and tertiary hospitals of Chongqing
- 第三军医大学学报 2021年43卷第4期页码：347-353
- 作者机构：
  
  400016 重庆，重庆医科大学附属第一医院心血管内科
- 作者简介：
  
  [ 肖骅，E-mail: xiaoheart1974@163.com XIAO Hua, E-mail:xiaoheart1974@163.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202008168
  中图分类号： R195.4;R541.75;R973.2
- 收稿：2020-08-20，
  
  修回：2020-11-18，
  
  纸质出版：2021-02-28
- 稿件说明：
移动端阅览
夏圳, 陆凯, 陈娴雅, 等. 重庆市二、三级医院老年非瓣膜性房颤患者抗栓现状调查[J]. 第三军医大学学报, 2021,43(4):347-353.

Zhen XIA, Kai LU, Xianya CHEN, et al. Anticoagulation status of elderly patients with non-valvular atrial fibrillation in secondary and tertiary hospitals of Chongqing[J]. Journal of Third Military Medical University, 2021, 43(4): 347-353.
夏圳, 陆凯, 陈娴雅, 等. 重庆市二、三级医院老年非瓣膜性房颤患者抗栓现状调查[J]. 第三军医大学学报, 2021,43(4):347-353. DOI： 10.16016/j.1000-5404.202008168.

Zhen XIA, Kai LU, Xianya CHEN, et al. Anticoagulation status of elderly patients with non-valvular atrial fibrillation in secondary and tertiary hospitals of Chongqing[J]. Journal of Third Military Medical University, 2021, 43(4): 347-353. DOI： 10.16016/j.1000-5404.202008168.

摘要

目的

调查重庆地区二、三级医院住院患者中≥75岁老年非瓣膜性房颤患者的抗凝治疗现状。

方法

纳入重庆市19家医院(6家二级医院，13家三级医院)2018年1月1日至12月31日期间收治的3 821名≥75岁的非瓣膜性房颤患者。通过电子病历系统采集患者的临床资料。比较分析上述患者的基线资料、CHA2DS2-VASc和HAS-BLED评分、抗凝率以及抗凝药物之间的差异。

结果

所有患者的CHA2DS2-VASc评分均≥2分，HAS-BLED评分≥3分的患者占25.0%。纳入的所有房颤患者总体抗凝率为36.2%，其中采用新型口服抗凝药(new oral anticoagulants，NOAC)和华法林抗凝者分别占10.8%和25.4%，单用抗血小板治疗而未抗凝者占43.3%，未采用任何抗栓治疗者占20.5%。二级医院房颤患者中NOAC、华法林处方率明显低于三级医院(5.3%

13.0%，

0.001；16.1%

28.9%，

0.001)。

结论

重庆市二、三级医院住院患者中，≥75岁的非瓣膜性房颤患者栓塞风险较高而出血风险较低，总体抗凝率较低，二级医院较三级医院更明显。有必要采取积极措施加强相关医务人员的培训，切实提高老年房颤患者的抗凝率。

Abstract

Objective

To investigate the current status of anticoagulation therapy for the elderly patients aged 75 years or over with non-valvular atrial fibrillation in secondary and tertiary hospitals in Chongqing.

Methods

A total of 3 821 patients aged 75 years old or over with non-valvular atrial fibrillation from 19 hospitals (6 secondary hospitals and 13 tertiary hospitals) in Chongqing between January 1

2018 and December 31

2018 were enrolled in this study. The clinical data of patients were collected by electronic medical record system. Their baseline data

scores of CHA2DS2-VASc and HAS-BLED

anticoagulant rate and anticoagulant drugs were compared and analyzed.

Results

All the patients had their CHA2DS2-VASc score ≥2

and those with HAS-BLED score ≥3 accounted for 25.0%. The overall anticoagulant rate was 36.2%. And of these patients

10.8% and 25.4% were treated with new oral anticoagulants (NOAC) and warfarin respectively

43.3% were treated with antiplatelet alone without anticoagulant

and 20.5% were not treated with any antithrombotic therapy. The prescription rate of NOAC and warfarin in these patients was much lower in secondary hospitals than tertiary hospitals (5.3%

13.0%

0.001; 16.1%

28.9%

0.001).

Conclusion

Among the inpatients in the secondary and tertiary hospitals of Chongqing

those aged 75 years or over with non-valvular atrial fibrillation have higher risk of embolism

lower risk of bleeding

but lower overall anticoagulation rate

especially in the secondary hospital when compared with the tertiary hospital. It is necessary to take positive measures to strengthen the training of relevant doctors in order to effectively improve the anticoagulation rate in these patients.

关键词

Keywords

references

XING L, LIN M, DU Z, et al .Epidemiology of atrial fibrillation in northeast China: a cross-sectional study, 2017-2019[J ] .Heart, 2020, 106(8): 590-595. DOI: 10.1136/heartjnl-2019-315397.

WANG Z, CHEN Z, WANG X, et al . The disease burden of atrial fibrillation in China from a national cross-sectional survey[J ] . Am J Cardiol, 2018, 122(5): 793-798. DOI: 10.1016/j.amjcard.2018.05.015.

SCHÄFER A, FLIERL U, BERLINER D, et al . Anticoagulants for stroke prevention in atrial fibrillation in elderly patients[J ] . Cardiovasc Drugs Ther, 2020, 34(4): 555-568. DOI: 10.1007/s10557-020-06981-3.

YⅡN G S, HOWARD D P, PAUL N L, et al . Recent time trends in incidence, outcome and premorbid treatment of atrial fibrillation-related stroke and other embolic vascular events: a population-based study[J ] . J Neurol Neurosurg Psychiatry, 2017, 88(1): 12-18. DOI: 10.1136/jnnp-2015-311947.

JAME S, BARNES G. Stroke and thromboembolism prevention in atrial fibrillation[J]. Heart, 2020, 106(1): 10-17. DOI: 10.1136/heartjnl-2019-314898.

ZHENG H J, OUYANG S K, ZHAO Y, et al . The use status of anticoagulation drugs for inpatients with nonvalvular atrial fibrillation in Southwest China[J ] . Int J Gen Med, 2017, 10: 69-77. DOI: 10.2147/ijgm.s128047.

董朝会, 郑环杰, 徐嘉蔚, 等.某院2012~2014年老年非瓣膜性房颤合并血栓栓塞并发症患者抗凝治疗现状分析[J].重庆医学, 2016, 45(16): 2167-2169. DOI: 10.3969/j.issn.1671-8348.2016.16.003.

DONG C H, ZHENG H J, XU J W, et al . Study on the anti coagulation therapy of non valvular atrial fibrillation elderly patients with thromboembolic complications from 2012 to 2014[J ] . Chongqing Med J, 2016, 45(16): 2167-2169. DOI: 10.3969/j.issn.1671-8348.2016.16.003.

LIP G Y H, NIEUWLAAT R, PISTERS R, et al . Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach[J ] . Chest, 2010, 137(2): 263-272. DOI: 10.1378/chest.09-1584.

PISTERS R, LANE D A, NIEUWLAAT R, et al . A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey[J ] . Chest, 2010, 138(5): 1093-1100. DOI: 10.1378/chest.10-0134.

黄从新, 张澍, 黄德嘉, 等.心房颤动:目前的认识和治疗的建议-2018[J].中国心脏起搏与心电生理杂志, 2018, 32(4): 315-368. DOI: 10.13333/j.cnki.cjcpe.2018.04.001.

HUANG C X, ZHANG P, HUANG D J, et al . Atrial fibrillation: current knowledge and treatment recommendations-2018[J ] .Chin J Cardiac Pacing Electrophysiol, 2018, 32 (4): 315-368. DOI: 10.13333/j.cnki.cjcpe.2018.04.001.

张新超, 于学忠, 陈凤英, 等.急性冠脉综合征急诊快速诊治指南(2019)[J].临床急诊杂志, 2019, 20(4): 253-262. DOI: 10.13201/j.issn.1009-5918.2019.04.001.

ZHANG X C, YU X Z, CHEN F Y, et al . Guidelines for emergency rapid diagnosis and treatment of acute coronary syndrome(2019)[J ] . J Clin Emergency, 2019, 20(4): 253-262. DOI: 10.13201/j.issn.1009-5918.2019.04.001.

王华, 梁延春.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志, 2018, 46(10): 760-789. DOI: 10.3760/cma.j.issn.0253-3758.2018.10.004.

WANG H, LIANG Y C. Chinese guidelines for the diagnosis and treatment of heart failure 2018[J]. Chin J Cardiol, 2018, 46(10): 760-789. DOI: 10.3760/cma.j.issn.0253-3758.2018.10.004.

中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中国实用内科杂志, 2018, 38(4): 292-344. DOI:10.19538/j.nk2018040108.

Branch of Diabetes Chinese Medical Association. Guidelines for the prevention and control of type 2 diabetes in China (2017 Edition)[J]. Chin J Pract Intern Med, 2018, 38(4): 292-344. DOI:10.19538/j.nk2018040108.

王斌, 李毅, 韩雅玲.稳定性冠心病诊断与治疗指南[J].中华心血管病杂志, 2018, 46(9): 680-694. DOI: 10.3760/cma.j.issn.0253-3758.2018.09.004.

WANG B, LI Y, HAN Y L. Guidelines for diagnosis and treatment of stable coronary heart disease[J]. Chin J Cardiol, 2018, 46(09): 680-694. DOI: 10.3760/cma.j.issn.0253-3758.2018.09.004.

吴江.神经病学[M].第2版.北京:人民卫生出版社, 2014: 150-180.

WU J. Neurology[M]. 2nd.Beijing: People's Medical Publishing House, 2014: 150-180.

ALLAN V, BANERJEE A, SHAH A D, et al . Net clinical benefit of warfarin in individuals with atrial fibrillation across stroke risk and across primary and secondary care[J ] . Heart, 2017, 103(3): 210-218. DOI: 10.1136/heartjnl-2016-309910.

RUFF C T, GIUGLIANO R P, BRAUNWALD E, et al .Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta- analysis of randomised trials[J ] .Lancet, 2014, 383(9921): 955-962. DOI: 10.1016/s0140-6736(13)62343-0.

LIP G Y H, AL-KHATIB S M, COSIO F G, et al . Contemporary management of atrial fibrillation: what can clinical registries tell us about stroke prevention and current therapeutic approaches?[J ] . J Am Heart Assoc, 2014, 3(4): e001179. DOI: 10.1161/jaha.114.001179.

GORST-RASMUSSEN A, SKJØTH F, LARSEN T B, et al . Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study[J ] . J Thromb Haemost, 2015, 13(4): 495-504. DOI: 10.1111/jth.12845.

KIRCHHOF P, BENUSSI S, KOTECHA D, et al .2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS[J ] . Eur Heart J, 2016, 37(38): 2893-2962. DOI:10.1093/eurheartj/ehw210.

JANUARY C T, WANN L S, CALKINS H, et al .2019 AHA/ACC/HRs focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the society of thoracic surgeons[J ] . Circulation, 2019, 140(2): e125-e151. DOI: 10.1161/cir.0000000000000665.

YUZAWA H, INOUE H, YAMASHITA T, et al . Rhythm versus rate control strategies regarding anticoagulant use in elderly non-valvular atrial fibrillation patients: Subanalysis of the ANAFIE (All Nippon AF In the Elderly) registry[J ] . J Cardiol, 2020, 76(1): 87-93. DOI: 10.1016/j.jjcc.2020.01.010.

闫静静, 秦明照.中国老年心房颤动患者抗凝治疗现状及分析[J].中国全科医学, 2018, 21(27): 3285-3289. DOI: 10.12114/j.issn.1007-9572.2018.00.079.

YAN J J, QIN M Z. Anticoagulation therapy for Chinese elderly patients with atrial fibrillation[J]. Chin Gen Pract, 2018, 21 (27): 3285-3289. DOI: 10.12114/j.issn.1007-9572.2018.00.079.

FRANKEL D S, PARKER S E, ROSENFELD L E, et al . HRS/NSA 2014 survey of atrial fibrillation and stroke: Gaps in knowledge and perspective, opportunities for improvement[J ] . Heart Rhythm, 2015, 12(8): e105-e105. DOI: 10.1016/j.hrthm.2015.04.039.

王长鹰, 胡大一.县级医院医生使用华法林预防非瓣膜性房颤患者脑卒中的调查[J].重庆医科大学学报, 2015, 40(5): 781-784. DOI:10.13406/j.cnki.cyxb.000640.

WANG C Y, HU D Y. Investigation on the use of warfarin in the prevention of stroke in patients with non-valvular atrial fibrillation among physicians from County-level hospitals[J]. J Chongqing Med Univ, 2015, 40(5): 781-784. DOI: 10.13406/j.cnki.cyxb.000640.

SILVERIO A, DI MAIO M, PROTA C, et al .Safety and efficacy of non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation[J ] . Eur Heart J Cardiovasc Pharmacother, 2019. DOI: 10.1093/ehjcvp/pvz073.

CALDEIRA D, NUNES-FERREIRA A, RODRIGUES R, et al . Non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation: a systematic review with meta-analysis and trial sequential analysis[J ] . Arch Gerontol Geriatr, 2019, 81: 209-214. DOI: 10.1016/j.archger.2018.12.013.

BAI Y, GUO S D, DENG H, et al . Effectiveness and safety of oral anticoagulants in older patients with atrial fibrillation: a systematic review and meta-regression analysis[J ] . Age Ageing, 2018, 47(1): 9-17. DOI: 10.1093/ageing/afx103.

董霞, 张华, 王维平, 等.老年房颤患者华法林抗凝治疗不足现状及原因[J].医学研究与教育, 2016, 33(2): 40-46.

DONG X, ZHANG H, WANG W P, et al . Deficiency status and influencing factors of oral walfarin anticoagulation in elderly patients with atrial fibrillation[J ] . Med Res Edu, 2016, 33(2): 40-46.

MAN-SON-HING M, NICHOL G, LAU A, et al . Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for Falls[J ] . Arch Intern Med, 1999, 159(7): 677-685. DOI: 10.1001/archinte.159.7.677.

MELKONIAN M, JARZEBOWSKI W, PAUTAS E, et al . Bleeding risk of antiplatelet drugs compared with oral anticoagulants in older patients with atrial fibrillation: a systematic review and meta-analysis[J ] . J Thromb Haemost, 2017, 15(7): 1500-1510. DOI: 10.1111/jth.13697.

MANT J, HOBBS F D, FLETCHER K, et al . Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial[J ] . Lancet, 2007, 370(9586): 493-503. DOI: 10.1016/s0140-6736(07)61233-1.[PubMed ]

胡志成, 蒋超, 郑黎晖, 等.2019年中国心房颤动医疗质量控制报告[J].中国循环杂志, 2020, 35(5): 427-437. DOI: 10.3969/j.issn.1000-3614.2020.05.003.

HU Z C, JIANG C, ZHENG L H, et al . 2019 Clinical performance and quality measures for atrial fibrillation in china[J ] . Chin Circ J, 2020, 35(5): 427-437. DOI: 10.3969/j.issn.1000-3614.2020.05.003.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

3 984例非瓣膜性心房颤动住院患者抗凝药物的使用情况及影响因素分析

良性前列腺增生老年患者术前沟通问题提示列表构建及其应用效果的随机对照研究

谷氨酰胺对老年髋部骨折患者术后早期营养支持耐受性及炎症反应的影响

复合氯胺酮麻醉对老年抑郁症患者电休克治疗的认知保护作用：一项随机对照研究