脑梗死合并心房颤动358例抗凝治疗状况分析

目的 了解心房颤动伴脑梗死住院患者抗凝治疗的情况,并比较与指南建议之间的差距.方法 对我院2008年1月至2012年6月收治的358例脑梗死合并心房颤动患者的临床资料进行回顾性分析,重点分析抗凝药物使用情况.结果 358例患者中254例既往有心房颤动史（70.9％）,在脑梗死发病前服用过华法林者11例,占有心房颤动病史患者的4.3％;11例患者国际标准化比值（INR）均＜1.5.出院患者中,20.9％接受华法林抗凝治疗.使用华法林与HAS-BLED评分,MRS评分及抗血小板药物呈负相关（OR分别为-1.974、-0.725、-4.170,P＜0.05或P＜0.01）.出院后给予华法林治疗的患者中,33.8％长期坚持服用华法林,用药剂量中位数为2.5 mg（1.25～3.75 mg）,INR控制在1.5～3.1之间.患者平均1个月（2周～2个月）复查一次凝血常规,INR在治疗目标范围内的时间百分比平均为（61.6±21.2）％.结论 脑梗死合并心房颤动患者的抗凝治疗率和INR达标率均较低,对出血的担忧和监测INR的不便影响了华法林的使用.

A retrospective study on patients with stroke and non-rheumatic atrial fibrillation treated with anticoagulation

Objective To investigate the current statues of anticoagulation therapy for ischemic stroke patients with atrial fibrillation（AF） and compared the difference with guidelines.Methods Three hundred and fifty-eight patients with cerebral infarction and atrial fibrillation in Xinhua Hospital Affiliated to Shanghai Jiaotong University from Jan.2008 to Jun.2012 were selected as our subjects.The data related to the antithrombotic therapy were collected and analyzed.Results Among patients with ischemic stroke,the rate of preexisting AF was 70.9% （254/358）,and warfarin taken rate was 4.3% （11/254） before stroke onset.Of warfarin taken patients,INR were less than 1.5.Of all out hospitalized patients,20.9% （68/326） were treated with warfarin therapy.There were the negative correlation between warfarin usage and HAS-BLED score,MRS score,antiplatelet drugs （OR =-1.974,-0.725,-4.170,P 〈 0.05 or P 〈 0.01）.Among patients with warfarin usage in hospital,33.8% of subjects （23/68） still remain on warfarin even out of hospital.The medium dosage was 2.5 mg （1.25-3.75 mg）,and INR was controlled at ranged of 1.5-3.1.Periods of warfarin therapeutic range （TTR） was （61.6 ± 21.2）%.Conclusion The anticoagulation treatment rate and INR were lower in patients cerebral infarction with atrial fibrillation.Warfar might no be universal use due to the bleeding concerns and un-onvenience of monitoring INR.