摘要
目的分析非瓣膜性心房颤动(NVAF)患者的抗凝治疗现状,分析口服抗凝药(OAC)治疗后血栓栓塞、出血发生情况。方法回顾性分析2016年1月至2020年1月东部战区总医院心血管内科收治的确诊为NVAF的457例患者临床资料。根据患者治疗方案分为抗凝组349例(76.4%)和未抗凝组108例(23.6%)。抗凝组又分为华法林亚组72例(15.8%)、达比加群酯亚组166例(36.3%)、利伐沙班亚组111例(24.3%);其中达比加群酯亚组与利伐沙班亚组合称为新型口服抗凝药(NOAC)组。采用CHA 2 DS 2-VASc评分、HAS-BLED评分评估血栓栓塞、出血风险,通过本中心患者病历系统或电话随访患者出院后服用OAC发生血栓栓塞、出血事件情况,回顾性分析上述临床资料。结果血栓栓塞风险中高危患者394例(86.2%),其中抗凝治疗303例(76.9%);高出血风险患者103例(22.5%),其中未抗凝患者28例(27.2%)。在血栓栓塞事件发生方面,抗凝组明显低于未抗凝组[20(5.7%)vs 34(31.5%),P<0.01];NOAC组与华法林亚组比较差异无统计学意义[16(5.8%)vs 4(5.6%),P>0.05];达比加群酯亚组优于利伐沙班亚组[5(3.0%)vs 11(9.9%),P<0.05]。在出血事件发生方面,抗凝组较未抗凝组高[19(5.4%)vs 0(0%),P<0.05];其中抗凝组有2例(0.6%)出现致命性脑出血,余为非致命性出血事件;NOAC组较华法林亚组低[9(3.2%)vs 10(13.9%),P<0.05],2组中各有1例患者发生致命性脑出血(0.3%vs 1.0%,P>0.05);达比加群酯亚组与利伐沙班亚组相当[4(2.4%)vs 5(4.5%),P>0.05]。结论NVAF患者抗凝治疗是必要的,其中OAC以选择NOAC较多。NOAC抗凝治疗与华法林抗凝治疗预防血栓栓塞效果相当,但较华法林安全。达比加群酯在预防血栓栓塞事件方面优于利伐沙班,不排除与研究中利伐沙班普遍剂量偏小有关,两者安全性相当。临床医师应强化抗凝意识,结合患者实际情况选择合适的口服抗凝药。
Objective To observe the status of anticoagulation treatment in patients with non-valvular atrial fibrillation(NVAF),and to analyze embolism and bleeding after oral anticoagulants(OAC)treatment.Methods A total of 457 patients diagnosed with NVAF during the hospitalization period in Eastern Theater General Hospital from January 2016 to June 2020 were enrolled.According to the patient's treatment,the enrolled patients were divided into anticoagulation group[349 cases(76.4%)]and non-anticoagulation group[108 cases(23.6%)].Anticoagulation group included warfarin group[72 cases(15.8%)],dabigatran group[166 cases(36.3%)],rivaroxaban group[111 cases(24.3%)].Dabigatran group and rivaroxaban group were called NOAC group.The CHA2DS2-VAS C score and HAS-BLED score were used to assess the risk of embolism and bleeding.The occurrence of embolism or bleeding in patients who were taken OAC were investigated by follow-up via telephone and/or the patient′s medical system,and the ret-rospective analysis was performed.Results A total of 394 patients(86.2%)were at medium and high risk of embolism,of which 303 cases(76.9%)were treated with OAC.103 cases(22.5%)were at high risk of bleeding,of which 28 cases were not treated with OAC(27.2%).In terms of embolic events,the anticoagulation group was significantly lower than the non-anticoagulation group(5.7%vs 31.5%),P<0.01.There was no significant difference between the NOAC group and the warfarin group(5.6%v s 4.6%),P>0.05.The dabigatran group was lower than the rivaroxaban group(3.0%vs 9.9%),P<0.05.In the bleeding events,the anticoagulation group was higher than the non-anticoagulation group(5.4%vs 0%),P<0.01,of which 2 cases(0.6%)in the anticoagulation group had fatal cerebral hemorrhage.The NOAC group was lower than the warfarin group(3.2%vs 13.9%),P<0.05,and 1 patient in each of the two groups had fatal cerebral hemorrhage(0.3%vs 1.0%),P>0.05.The dabigatran group was equivalent to the rivaroxaban group(2.4%vs 4.5%),P>0.05.Conclusion This study show that anticoagulation therapy is necessary,and most NVAF patients choice NOAC to anticoagulant.NOAC anticoagulation therapy is equivalent to warfarin,but it is safer than warfarin.Dabigatran is better than rivaroxaban in preventing embolic events,and the safety of the two is equivalent.Obviously,clinicians should strengthen the awareness of anticoagulation and choose appropriate OAC based on the actual situation of the patient.
作者
李丹丹
庄微
宫剑滨
LI Dan-dan;ZHUANG Wei;GONG Jian-bin(Department of Cardiovascular Medicine,Jinling Hospital,Nanjing Medical University/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)
出处
《东南国防医药》
2021年第4期363-367,共5页
Military Medical Journal of Southeast China
关键词
心房颤动
抗凝
新型口服抗凝药
华法林
atrial fibrillation
anticoagulant
new oral anticoagulant
warfarin
