| 摘要: |
| 目的探讨浙江舟山地区非瓣膜性心房颤动并卒中高危患者华法林抗凝治疗的影响因素。方法回顾性分析非瓣膜性心房颤动患者988例。选择心房颤动合并卒中高危患者522例，其中男214例，女308例，年龄44~93（78.4±8.2）岁。分成华法林治疗组和非华法林治疗组，分析两组心房颤动患者的一般资料；对所有心房颤动患者进行CHADS2评分，CHADS2≥2为卒中高危患者。多因素logistic回归分析得出影响本地区心房颤动卒中高危患者华法林抗凝治疗的因素。结果舟山地区非瓣膜性心房颤动卒中高危患者华法林治疗率为31.2%（163/522）。多因素logistic回归分析显示：卒中/短暂性脑缺血发作（TIA）（OR=3.363，95%CI：3.058～3.799，P＜0.01）、非阵发性心房颤动（OR=2.415，95%CI：1.905～3.087，P＜0.01）以及LVEF≤40%（OR=2.417，95%CI：1.770～2.516，P＜0.05）的患者更可能予以华法林抗凝治疗；≥80岁（OR=0.510，95%CI：0.302～0.710，P＜0.05）、不方便检测INR（OR=0.510,95%CI：0.314～2.483，P＜0.05）以及肾功能不全（OR=0.743，95%CI：0.654～0.840，P＜0.05）患者使用华法林抗凝治疗的可能性较小。结论舟山地区非瓣膜性心房颤动并卒中高危患者华法林抗凝率较低。既往卒中/TIA病史、非阵发性心房颤动以及左心室功能不全的心房颤动患者与华法林治疗有关；而高龄、肾功能不全及不方便检测INR与华法林未治疗有关。 |
| 关键词: 心房颤动 华法林 CHADS2 评分 缺血性卒中 影响因素 |
| DOI： |
| 分类号: |
| 基金项目:浙江省舟山市医药卫生科技计划项目 |
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| Factors related to anti-coagulating drug use in atrial fibrillation patients with high stroke risk |
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ZHENG Yangjian,WANG Wenna,LIN Hanli,ZHONG Bifeng,LIU Shankuan,KONG Xiangbin,ZHANG Zhedong,FENG Sujun,ZHOU Dacheng
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Zhejiang Putou Hospital
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| Abstract: |
| Objective To analyze the factors associated with the anti-coagulating drug use in non-valvular atrial fibrillation (NVAF) patients with high stroke risk. Methods A total of 988 NVAF patients diagnosed with NVAF at two general hospitals in Putuo District at Zhoushan Municipality from February 2013 to February 2015 were consecutively enrolled in this study. Patients were divided into warfarin use group and non-warfarin use group. Clinical data and CHADS2 score for all AF patients were
obtained. Those with CHADS2≥2 were considered to be at high stroke risk. Independent factors associated with warfarin use were
evaluated by logistic regression analysis. Results Among 988 AF patients, 522 patients with high stroke risk (CHADS2 ≥2), including 214 males and 308 females with mean age 78.4 ± 8.2 years, were eligible for analysis. In this study the AF patients with high stroke risk receiving warfarin therapy accounted for 31.2% (163/522). Multivariate logistic analysis showed that previous stroke/TIA(OR=3.363, 95%CI:3.058～3.799, P＜0.01), non-paroxysmal AF (OR=2.415, 95%CI:1.905～3.087, P＜0.01) and LVEF≤
40%(OR=2.147, 95%CI :1.770～2.516, P＜0.05) were associated with warfarin use, whereas Age≥80y (OR=0.510, 95%CI:0.302～ 0.710, P＜0.05), inconvenience of INR testing (OR=0.510, 95%CI:0.314～2.483, P＜0.05) and renal impairment (OR=0.743, 95%CI: 0.654～0.840, P＜0.05) were associated with a lower likelihood of warfarin use. Conclusion The application of warfarin therapy in non-valvular AF patients with high stroke risk is low in this study. Previous stroke/TIA, non-paroxysmal AF and left ventricular dysfunction are positively associated with warfarin use. Advanced age, inconvenience of INR testing and renal impairment are negatively associated with warfarin use. |
| Key words: Atrial fibrillation Warfarin CHADS2 Stroke Factors |
