老年非瓣膜性心房颤动患者的抗栓治疗：一项试点研究。
Antithrombotic therapy in elderly patients with non-valvular atrial fibrillation: a pilot study.
作者信息
Xiang Wei, Zhang Jingwei, Liu Meilin, Liu Fang, Feng Xueru, Wang Yuchuan
机构信息
Department of Geriatrics, Peking University First Hospital, Beijing, People's Republic of China.
出版信息
Clin Interv Aging. 2015 Mar 2;10:515-9. doi: 10.2147/CIA.S67974. eCollection 2015.
OBJECTIVE
Non-valvular atrial fibrillation (NVAF) is one common arrhythmia in the elderly. However, use of antithrombotic therapy in this population is not well known in the People's Republic of China. This study aimed at investigating antithrombotic therapy status in elderly patients with NVAF in our hospital.
METHODS
A cross-sectional study of consecutive geriatric patients aged ≥60 years with NVAF who discharged from our hospital between January 2012 and December 2013 were collected. CHA2DS2-VASc score (cardiac failure or dysfunction, hypertension, age ≥75 [doubled], diabetes, stroke or transient ischemic attack [doubled], vascular disease, age 65-74, and sex category [female]) was used to analyze antithrombotic indication.
RESULTS
We consecutively collected data of 1,000 discharged elderly patients (≥60 years) with NVAF (mean age 75.3±8.0 years, 75 years or older 54.7%, female 42.7%). The proportion of paroxysmal atrial fibrillation and non-paroxysmal atrial fibrillation (persistent or permanent) patients were 39.4% and 60.6%, respectively. Among 1,000 patients, 29.1% received oral anticoagulant therapy (OAT), including warfarin (27.8%) and novel oral anticoagulants (1.3%), 39.5% of patients received antiplatelet therapy, and 31.4% received neither therapy. Based on CHA2DS2-VASc score for stroke risk stratification, 68.9% patients with score ≥1 and 70.2% patients with score ≥2 received antithrombotic therapy, while the rates of OAT were 29.1% and 29.5%, respectively. Among patients with high stroke risk, those with paroxysmal atrial fibrillation were less likely to receive OAT compared with the patients with non-paroxysmal atrial fibrillation (19.5% vs 35.7%, P<0.001). The patients ≥75 years old had lower rate of OAT than the patients <75 years old (25.8% vs 34.8%, P=0.003). The patients with coronary artery disease had lower rate of OAT than the patients without coronary artery disease (24.4% vs 33.4%, P=0.003). Sex and history of stroke or transient ischemic attack had no effect on the use of OAT (30.8% vs 27.9%, P=0.326 and 28.8% vs 29.8%, P=0.761, respectively).
CONCLUSION
OAT in elderly patients with NVAF in our hospital is underused, especially in those patients with higher risk of stroke.
目的
非瓣膜性心房颤动（NVAF）是老年人常见的心律失常。然而，中华人民共和国这一人群中抗栓治疗的使用情况尚不清楚。本研究旨在调查我院老年NVAF患者的抗栓治疗状况。
方法
对2012年1月至2013年12月期间从我院出院的年龄≥60岁的连续性老年NVAF患者进行横断面研究。采用CHA2DS2-VASc评分（心力衰竭或功能障碍、高血压、年龄≥75岁[加倍]、糖尿病、卒中或短暂性脑缺血发作[加倍]、血管疾病、年龄65 - 74岁和性别类别[女性]）分析抗栓治疗指征。
结果
我们连续收集了1000例出院的老年NVAF患者（≥60岁）的数据（平均年龄75.3±8.0岁，75岁及以上者占54.7%，女性占42.7%）。阵发性心房颤动和非阵发性心房颤动（持续性或永久性）患者的比例分别为39.4%和60.6%。在1000例患者中，29.1%接受口服抗凝治疗（OAT），包括华法林（27.8%）和新型口服抗凝药（1.3%），39.5%的患者接受抗血小板治疗，31.4%的患者未接受任何治疗。根据CHA2DS2-VASc评分进行卒中风险分层，评分≥1的患者中有68.9%、评分≥2的患者中有70.2%接受了抗栓治疗，而OAT的比例分别为29.1%和29.5%。在高卒中风险患者中，阵发性心房颤动患者接受OAT的可能性低于非阵发性心房颤动患者（19.5%对35.7%，P<0.001）。≥75岁的患者OAT发生率低于<75岁的患者（25.8%对34.8%，P = 0.003）。冠心病患者的OAT发生率低于无冠心病的患者（24.4%对33.4%，P = 0.003）。性别以及卒中或短暂性脑缺血发作史对OAT的使用无影响（分别为30.8%对27.9%，P = 0.326；28.8%对29.8%，P = 0.761）。
结论
我院老年NVAF患者的OAT使用不足，尤其是在卒中风险较高的患者中。
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