大学医院心房颤动患者的抗栓治疗现状

Status of antithrombotic therapy for patients with atrial fibrillation in university hospitals.

作者信息

Albers G W, Yim J M, Belew K M, Bittar N, Hattemer C R, Phillips B G, Kemp S, Hall E A, Morton D J, Vlasses P H

机构信息

Stanford University Medical Center, Palo Alto, CA, USA.

出版信息

Arch Intern Med. 1996 Nov 11;156(20):2311-6.

PMID:8911237

Abstract

BACKGROUND

The risk of stroke in patients with atrial fibrillation can be significantly reduced with antithrombotic therapy. Despite this, many physicians remain hesitant to prescribe warfarin sodium or aspirin therapy for patients with atrial fibrillation.

OBJECTIVE

To assess the use of antithrombotic therapy in patients with atrial fibrillation at 6 academic hospitals in the United States.

METHODS

Records were reviewed from consecutive hospital admissions of 309 patients with atrial fibrillation at 6 members of the University Health System Consortium, Oak Brook, III, which is a member driven alliance of 70 academic health centers in the United States. Risk factors for stroke, contraindications to anticoagulant therapy, and use of antithrombotic therapy at admission and discharge were recorded.

RESULTS

The mean age of patients was 71.6 years, 54% had chronic, 22% paroxysmal, and 24% new-onset atrial fibrillation. Eighty-two percent of the patients had cardiovascular risk factors that have been associated with increased risk of stroke. At least 1 relative contraindication to anticoagulant therapy was present in 44%. At the time of admission. 32% of the patients with previously diagnosed atrial fibrillation (n = 235) were receiving warfarin (or warfarin plus aspirin), 31% were receiving aspirin alone, and 36% were receiving no antithrombotic therapy. At discharge (n = 230), 41% of these patients were taking warfarin (or warfarin plus aspirin) and 36% were taking aspirin. Forty-four percent of the patients with risk factors for stroke and no contraindications to anticoagulation (n = 134) were discharged on a regimen of warfarin (or warfarin plus aspirin), 34% were discharged on a regimen of aspirin, and 22% received no antithrombotic therapy.

CONCLUSIONS

About half of the patients with atrial fibrillation admitted to these academic hospitals had clinical risk factors that are associated with increased risk of stroke and no contraindications to anticoagulation. Antithrombotic therapy was underused in these patients.

摘要

背景

抗血栓治疗可显著降低心房颤动患者的中风风险。尽管如此，许多医生在为心房颤动患者开华法林钠或阿司匹林治疗时仍犹豫不决。

目的

评估美国6家学术医院中心房颤动患者抗血栓治疗的使用情况。

方法

回顾了美国大学卫生系统联盟（位于伊利诺伊州橡树溪，由70家学术健康中心组成的成员驱动联盟）的6家成员医院连续收治的309例心房颤动患者的记录。记录中风的危险因素、抗凝治疗的禁忌症以及入院和出院时抗血栓治疗的使用情况。

结果

患者的平均年龄为71.6岁，54%患有慢性心房颤动，22%为阵发性心房颤动，24%为新发心房颤动。82%的患者有与中风风险增加相关的心血管危险因素。44%的患者至少有1项抗凝治疗的相对禁忌症。入院时，先前诊断为心房颤动的患者（n = 235）中，32%正在接受华法林（或华法林加阿司匹林）治疗，31%仅接受阿司匹林治疗，36%未接受抗血栓治疗。出院时（n = 230），这些患者中有41%服用华法林（或华法林加阿司匹林），36%服用阿司匹林。有中风危险因素且无抗凝禁忌症的患者（n = 134）中，44%出院时接受华法林（或华法林加阿司匹林）治疗方案，34%出院时接受阿司匹林治疗方案，22%未接受抗血栓治疗。