Jedsadayanmata Arom
Center of Pharmaceutical Outcomes Research, Department ofPharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
J Med Assoc Thai. 2013 Jan;96(1):91-8.
Antithrombotic therapy is essential in patients with atrial fibrillation (AF) to prevent systemic thromboembolism, particularly ischemic stroke. Several studies conducted in North America and European countries revealed that AF patients at high risk for thromboembolism did not adequately receive antithrombotic therapy as recommended by relevant guidelines. However such a few studies were reported from Asian countries.
To describe patterns and adherence to the guideline of antithrombotic therapy in ambulatory patients with nonvalvular AF in Thailand.
From an electronic medical database, data of all patients that were diagnosed with AF and presented to the ambulatory care clinic between June 1 and September 30, 2008 were retrieved for analysis. The most recently prescribed antithrombotics and associated risk factors for thromboembolism were reviewed for patterns and adherence to guidelines of antithrombotic therapy according to the CHADS2 (congestive heart failure, hypertension, age >75, diabetes and stroke/transient ischemic attack) score.
Five hundred thirteen AFpatients were identified, ofthese, 369 patients had no valvular heart diseases or replacement and were recruited into data analysis. Among non-valvularAF patients, 138 (37.4%), 127 (34.4%), and 1l04 (28.2%) patients were classified as high (CHADS2 score > or =2), intermediate (CHAD S2 = I), and low (CHADS2 = 0) risk for ischemic stroke, respectively. Patients who were classified as low and intermediate risk were prescribed warfarin as antithrombotic therapy in 51.0% and 52.8%, respectively. Among high-risk patients, 70.3% were prescribed warfarin while 19.6% received only antiplatelets and 10.1% received no antithrombotic therapy.
The present study has demonstrated that a proportion of non-valvular AF patients at high-risk for ischemic stroke had not received anticoagulation therapy as recommended by relevant guidelines. Further low-risk patients were over-treated with anticoagulants. The finding should prompt health care policy makers to take action to improve quality of care for these patients.
抗栓治疗对于心房颤动（AF）患者预防全身性血栓栓塞，尤其是缺血性卒中至关重要。在北美和欧洲国家进行的多项研究表明，血栓栓塞高风险的AF患者未按照相关指南的建议充分接受抗栓治疗。然而，亚洲国家报道的此类研究较少。
描述泰国非瓣膜性AF门诊患者抗栓治疗的模式及对指南的依从性。
从电子医疗数据库中检索2008年6月1日至9月30日期间诊断为AF并就诊于门诊护理诊所的所有患者的数据进行分析。根据CHADS2（充血性心力衰竭、高血压、年龄>75岁、糖尿病和卒中/短暂性脑缺血发作）评分，回顾最近开具的抗栓药物及血栓栓塞相关危险因素，以分析抗栓治疗模式及对指南的依从性。
共识别出513例AF患者，其中369例无瓣膜性心脏病或人工瓣膜置换，纳入数据分析。在非瓣膜性AF患者中，分别有138例（37.4%）、127例（34.4%）和104例（28.2%）患者被分类为缺血性卒中高风险（CHADS2评分≥2）、中风险（CHADS2 = 1）和低风险（CHADS2 = 0）。低风险和中风险患者分别有51.0%和52.8%接受华法林作为抗栓治疗。在高风险患者中，70.3%接受华法林治疗，19.6%仅接受抗血小板治疗，10.1%未接受抗栓治疗。
本研究表明，一部分缺血性卒中高风险的非瓣膜性AF患者未按照相关指南的建议接受抗凝治疗。此外，低风险患者存在抗凝治疗过度的情况。这一发现应促使医疗保健政策制定者采取行动，改善这些患者的护理质量。
