中国非瓣膜性心房颤动急性缺血性脑卒中患者出院时华法林的使用情况。
Use of Warfarin at Discharge Among Acute Ischemic Stroke Patients With Nonvalvular Atrial Fibrillation in China.
机构信息
From the Department of Neurology (X.Y., Z.L., Chunjuan Wang, Y.P., H.L., Yilong Wang, Yongjun Wang, X.Z., L.L.), Tiantan Clinical Trial and Research Center for Stroke (Z.L., C.W., Y.P., H.L., Yilong Wang, Yongjun Wang), Division of Vascular Neurology (X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Cerebrovascular Disease, China National Clinical Research Center for Neurological Diseases, Beijing, China (Z.L., X.Z., L.L., Chunxue Wang, H.L., Y.W., Y.W.); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine, Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (R.G.H.).
出版信息
Stroke. 2016 Feb;47(2):464-70. doi: 10.1161/STROKEAHA.115.011833. Epub 2015 Dec 22.
BACKGROUND AND PURPOSE
Guidelines recommend oral anticoagulation for ischemic stroke patients with atrial fibrillation, and previous studies have shown the underuse of anticoagulation for these patients in China. We sought to explore the underlying reasons and factors that currently affect the use of warfarin in China.
METHODS
From June 2012 to January 2013, 19 604 patients with acute ischemic stroke were admitted to 219 urban hospitals voluntarily participating in the China National Stroke Registry II. Multivariable logistic regression models using the generalized estimating equation method were used to identify patient/hospital factors independently associated with warfarin use at discharge.
RESULTS
Among the 952 acute ischemic stroke patients with nonvalvular atrial fibrillation, 19.4% were discharged on warfarin. The risk of bleeding (52.8%) and patient refusal (31.9%) were the main reasons for not prescribing anticoagulation. Larger/teaching hospitals were more likely to prescribe warfarin. Older patients, heavy drinkers, patients with higher National Institutes of Health Stroke Scale score on admission were less likely to be given warfarin, whereas patients with history of heart failure and an international normalized ratio between 2.0 and 3.0 during hospitalization were significantly associated with warfarin use at discharge.
CONCLUSIONS
The rate of warfarin use remains low among patients with ischemic stroke and known nonvalvular atrial fibrillation in China. Hospital size and academic status together with patient age, heart failure, heavy alcohol drinking, international normalized ratio in hospital, and stroke severity on admission were each independently associated with the use of warfarin at discharge. There is much room for improvement for secondary stroke prevention in nonvalvular atrial fibrillation patients in China.
背景与目的
指南推荐对伴有心房颤动的缺血性脑卒中患者进行口服抗凝治疗，既往研究显示中国此类患者抗凝治疗的使用率较低。本研究旨在探讨目前影响中国华法林使用的潜在原因和相关因素。
方法
2012 年 6 月至 2013 年 1 月，共有 19604 例急性缺血性脑卒中患者自愿入组参加中国国家卒中登记研究 II （China National Stroke Registry II），这些患者来自全国 219 家城市医院。采用广义估计方程的多变量 logistic 回归模型，分析与出院时使用华法林相关的患者/医院因素。
结果
在 952 例伴有非瓣膜性心房颤动的急性缺血性脑卒中患者中，19.4%的患者出院时接受了华法林治疗。出血风险（52.8%）和患者拒绝（31.9%）是未开具抗凝治疗的主要原因。规模较大/教学医院更倾向于开具华法林处方。高龄、大量饮酒、入院时 NIHSS 评分较高的患者较少使用华法林，而心力衰竭史和住院期间 INR 为 2.0~3.0 的患者出院时使用华法林的可能性显著增加。
结论
中国缺血性脑卒中伴已知非瓣膜性心房颤动患者华法林使用率仍然较低。医院规模和学术地位以及患者年龄、心力衰竭、大量饮酒、入院时 INR 及入院时脑卒中严重程度与出院时华法林的使用独立相关。中国非瓣膜性心房颤动患者的二级预防仍有较大的提升空间。
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