老年非瓣膜性心房颤动抗凝治疗现状分析

目的分析影响老年非瓣膜性心房颤动患者抗凝治疗的因素,为提高老年心房颤动患者抗凝治疗寻求解决方法。方法对2009-10-01—2010-04-30入住北京协和医院,年龄≥65岁的老年非瓣膜性心房颤动患者进行门诊及电话随访,观察分析全因死亡、抗凝比例、未选择抗凝的原因、抗凝终止的原因、不抗凝(抗凝终止)后的抗栓方法等指标。结果共70例连续入院的患者纳入研究,平均随访9.1个月(6.0~13.5个月)。有效随访63例,其中包括年龄<75岁组33例和年龄≥75岁组30例。失访7例(10%)。随访期间共8例(12.7%)死亡,包括年龄<75岁组1例(3%)和年龄≥75岁组7例(23.3%)。有效随访病例中,进行抗凝治疗的仅16例(25.4%),这16例中INR达标13例。8例死亡患者均未进行抗凝治疗,其中6例称大夫未交待抗凝,另2例有明确抗凝禁忌证。结论老年心房颤动患者抗凝比例低,有效抗凝率低。抗凝过程中中断的比例高。解决老年心房颤动患者抗凝过程的具体困难是有效治疗的关键。     

老年非瓣膜性心房颤动患者抗凝情况回顾性分析

目的 分析老年非瓣膜性心房颤动(NVAF)患者抗凝治疗情况和影响因素,为抗凝药物的规范化应用提供参考。方法 回顾性分析明光市人民医院2020年1月—2020年12月出院诊断中含有NVAF的250例老年患者的临床资料,根据患者抗凝治疗情况分组：抗凝治疗组(n=75)和非抗凝治疗组(n=175)。对比分析2组临床特征,分别使用卒中风险评分(CHA2DS2-VASc)、出血风险评分(HAS-BLED)评估患者血栓栓塞、出血风险,分析不同血栓栓塞风险、出血风险患者抗凝治疗情况,总结患者未抗凝原因。应用二元Logistic回归分析明确影响老年NVAF患者抗凝治疗的因素。结果 250例老年NVAF患者中男性135例,女性115例,年龄60～93岁,平均年龄(77.9±9.0)岁;其中年龄≥75岁152例(60.80%), BMI>28.0 kg/m² 23例(9.20%),吸烟45例(18.00%),饮酒36例(14.40%),持续性房颤186例(74.40%),病程<2年124例(49.60%),合并心功能不全184例(73.60%),因NVAF就诊时使用抗凝药...     

非瓣膜性心房颤动患者导管消融术后抗凝策略的研究进展

非瓣膜性心房颤动患者导管消融术后的卒中预防策略尚存争议,现有指南大多推荐根据CHA2DS2-VASc评分制定抗凝策略,建议CHA2DS2-VASc评分≥2分的卒中高风险患者术后长期抗凝.但目前临床实践中,抗凝出血风险和患者依从性等问题仍待解决,对心房颤动患者术后卒中来源的剖析、卒中风险的全面评估以及个体化卒中预防策略的...     

新型口服抗凝药物在老年非瓣膜性心房颤动患者抗凝治疗中的作用

心房颤动（房颤）是临床上常见的快速性心律失常,是卒中和栓塞的独立危险因素。大多数非瓣膜性房颤患者超过65岁,对老年房颤患者行抗凝治疗可有效预防血栓栓塞事件,降低患者的致残率和致死率。目前指南推荐老年房颤患者使用新型口服抗凝药,该文介绍老年房颤患者抗凝治疗选择。     

非瓣膜性心房颤动患者围术期的抗凝治疗

大多数非瓣膜性心房颤动(NVAF)患者需长期应用口服抗凝药物,以减少中风及系统性栓塞的风险。这些患者在接受外科手术或侵入性操作时出血风险增加,部分患者在围术期需暂时中断抗凝治疗。近年来,对于NVAF患者围术期暂时中断抗凝治疗的适应症、时间、暂时中断口服抗凝药物后抗凝治疗的桥接,以及术后抗凝治疗的重新应用已有较多的临床研究。本文简要介绍NVAF患者围术期抗凝治疗的研究现状。     

陕西关中地区县级医院非瓣膜性心房颤动患者的抗凝治疗现况及影响因素

目的 了解陕西关中地区县级医院非瓣膜性心房颤动(房颤)患者的抗凝治疗现况及影响因素。方法 通过查询住院电子病历和门诊存档病历,采用临床资料分析、电话随访+面对面随访、问卷调查的方式,筛选出2019年1～12月于陕西关中地区8家县级医院心内科就诊的门诊和住院房颤患者,分析中高危栓塞风险患者的抗凝治疗现况、华法林和非维生素K拮抗剂口服抗凝药(NOACs)长期抗凝治疗依从性及影响因素。问卷调查心内科医生房颤患者的栓塞风险评估、抗凝药物选择、栓塞风险及抗凝获益宣教情况。结果 共纳入房颤患者4 577例,平均年龄(67.9±10.1)岁,其中男性2 793例,女性1 784例,门诊患者1 968例,住院患者2 609例。采用CHA2DS2-VASc评分,门诊抗凝治疗率为14.9%,住院抗凝治疗率为44.9%。华法林抗凝治疗1年依从性良好、一般、较差的患者比例分别为24.0%、26.7%、49.3%;NOACs抗凝治疗1年依从性良好、一般、较差的患者比例分别为32.7%、25.2%、42.1%。影响患者抗凝治疗依从性的主要因素:频繁监测凝血及国际标准化比值(INR)难以保持目标水平、过于担忧出血风...     

达比加群酯在非瓣膜性心房颤动抗凝治疗中的作用及进展

非瓣膜性心房颤动(NVAf)是最常见的心律失常之一,是心脏病学界仍待攻克的世界性难题。据统计,正常人群中脑卒中发生率为1%,心房颤动(房颤)患者发生脑卒中的危险为正常人群的5~7倍,而且房颤引起的脑卒中后果更为严重,是房颤致残致死的最重要原因。随着人类社会疾病谱的变化,房颤     

非瓣膜病心房颤动患者抗凝治疗的健康教育

<正>心房颤动(简称房颤)是临床上最常见的心律失常之一,其潜在的危险在于引发血栓栓塞,是缺血性脑卒中最强烈的独立危险因素。房颤以往多发生于风湿性心脏瓣膜病患者,近年来非瓣膜病房颤(non-valvular atrial fibrillation,NVAF)的发生率越来越高,已     

华法林在非瓣膜性心房颤动抗凝治疗中的临床应用观察

目的 探讨非瓣膜性心房颤动具有高风险血栓栓塞患者运用华法林抗凝治疗后脑卒中的发生率及高龄患者(≥65岁)运用华法林的安全性.方法 观察我院2005年1月-2007年12月心内科住院治疗的非瓣膜性心房颤动具有高风险血栓栓塞患者204例,按照是否接受华法林抗凝治疗分为两组,治疗组在常规治疗基础上加用华法林抗凝,起始剂量为2.0 mg/d,监测国际标准化比值(INR)在2.0～3.0之间),对照组常规治疗,未用华法林抗凝治疗.比较两组年脑卒中发生率,其次将治疗组按照年龄是否≥65岁分为高龄组和低龄组,比较两组年出血率及脑卒中发生率.结果 接受华法林抗凝治疗组年脑卒中发生率明显低于对照组(P<0.05),治疗组中高龄患者与低龄患者的年出血率明显差异(P>0.05).结论 非瓣腊性心房勯动患者运用华法林抗凝治疗后明显降低脑卒中发生率,且高龄患者运用适当剂量华法林抗凝治疗是安全的.     

非瓣膜性心房颤动患者的综合治疗

心房颤动(AF)是临床上最常见的心律失常类型,既往AF管理侧重于AF相关栓塞预防以及心室率和节律的控制。近年来,AF综合管理的理念逐渐普及。AF综合管理强调在做好AF相关栓塞预防及症状控制的基础上,同时关注患者生活质量的改善以及合并症的管理,以进一步改善患者的预后。本文就非瓣膜性心房颤动患者的抗凝治疗、症状管理及危险因素的控制作一综述。     

华法林在慢性心房颤动抗凝治疗中的应用

目的:探讨华法林在慢性心房颤动(CAf)抗凝治疗中的合理应用。方法:共入选234例具有血栓栓塞高风险的CAf患者,给予华法林抗疑治疗,监测国际标准化比值(INR)以调整华法林用量,随访观察华法林的不同起始剂量、不同的抗凝强度以及高龄(≥65岁)等因素对INR达标时间、INR稳定值、华法林维持量、出血率及栓塞率的影响。结果:分别采用开始剂量为普通剂量(2．5mg／d)与小剂量(1．25 mg／d)2种方式,两者最终获得稳定的INR、华法林维持量及出血率均差异无统计学意义,但前者能明显缩短INR首次达标时间及获得INR 稳定值的时间(均P<0．01),并有降低栓塞率的趋势;与低强度抗凝相比,中强度抗凝能显著降低栓塞率(P< 0．05),虽然伴出血率明显升高(P<0．05),但无严重出血发生;在相同的目标INR内,高龄患者出血率并不增加,但所需的华法林维持量有所降低(P<0．01)。结论:以普通量的华法林开始CAf抗凝治疗是安全的,抗栓塞效果优于小剂量;对具有栓塞高风险的CAf需保持中强度抗凝水平;华法林抗凝治疗并不增加高龄患者的出血风险。     

社区老年非瓣膜性心房颤动患者的抗凝治疗现状

目的:探讨社区老年非瓣膜性心房颤动(房颤)患者抗凝治疗现状。方法:采用整群抽样方法,抽取上海市长宁区3个社区中年龄≥65岁的常住居民,入选通过心电图或24 h动态心电图及心脏超声检查确诊为非瓣膜性房颤的患者(n=218),对所有患者进行统一问卷调查,包括基本情况、疾病史以及用药情况,并计算CHADS2评分。结果:入选患者中,卒中高危患者(CHADS2评分≥2)有167例,实际接受抗凝治疗的仅23例(13.8%)。对未抗凝治疗原因分析显示,医生未实施抗凝治疗高达63.2%,是抗凝治疗率低的主要原因。结论:社区老年非瓣膜病房颤卒中高危患者抗凝治疗率低,需规范房颤抗凝治疗。     

华法令在心房颤动患者的应用研究

目的　探讨简化的抗凝指标检测法及低抗凝强度的华法令应用于心房颤动 (简称房颤 )的可行性。方法　 115例房颤患者随机分为低抗凝强度组 (INR 1 5～ 2 0 )和标准抗凝强度组 (INR 2 1～ 3 0 ) ,在服华法令后第4日采血检测INR ,以后每周 1次至每月检测 1次。结果　 95 7%病例第 4日检测的INR≤ 3 0 ,只有 1例INR达4 0伴皮肤出血 (占 0 9% ) ;平均随访 3.4年 ,低抗凝强度组栓塞年发生率 0 98% ,标准抗凝强度组未发生栓塞 ,但两组比较差异无显著意义 (P >0 0 5 ) ;出血年发生率分别为 0 4 9%和 3 74 % ,两组比较差异有显著意义 (P <0 0 5 )。结论　简化的抗凝指标检测法是可行的 ;对非瓣膜性房颤可考虑应用低抗凝强度的华法令 ,瓣膜性房颤仍需标准抗凝强度的华法令治疗。     

心房颤动患者抗凝的新选择—ximelagatran

华法林是预防心房颤动血栓栓塞的有效药物,但由于药物本身的局限性使其没有充分应用。ximelagatran是一种有前途的口服直接凝血酶抑制剂,将来可能会取代华法林。本文将对华法林抗凝的益处和局限性,ximelagatran的药理学特点、临床试验评价和优势作一综述。     

Anticoagulation in atrial fibrillation: selected controversies including optimal anticoagulation intensity,treatment of intracerebral hemorrhage

Clinical trials during the past 20 years have revolutionized the antithrombotic management of atrial fibrillation. Based on consideration of 30 randomized trials involving 29,017 participants, adjusted-dose warfarin remains the most efficacious prophylaxis against stroke for atrial fibrillation patients at moderate-to-high risk (compared with antiplatelet agents, warfarin reduces stroke by about 40%). The optimal INR for prevention of stroke for most atrial fibrillation patients is probably 2.0–2.5; INRs of 1.6–1.9 provide substantial protection, 80–90% of that afforded by higher intensities. Warfarin-associated intracerebral hemorrhage is an increasing problem as more elderly patients with atrial fibrillation are anticoagulated. Modest reductions in blood pressure results in large decreases in this most dreaded complication of warfarin; anticoagulation of elderly atrial fibrillation patients should be accompanied by a firm commitment to control hypertension. Warfarin-associated intracerebral hemorrhage has a 50% early mortality. A wide range of acute treatments to urgently reverse anticoagulation have been recommended by experts, but prevention is a far better option than treatment of this devastating problem. Disclosure: Dr. Hart chaired the Data Safety Monitoring Boards of the SPORTIF III and V trials and received compensation from Astrazeneca Pharma for this activity; he has had add no affiliation since the trials ended in 2004. He serves on the steering committee, stroke advisory committee and/or data safety monitoring board of several ongoing clinical trials of novel anticoagulants in atrial fibrillation patients.     

非瓣膜性心房颤动血栓形成的相关因素分析

目的通过观察非瓣膜性心房颤动患者血浆C反应蛋白、D-二聚体的浓度及左心房直径、射血分数的水平,研究C反应蛋白与非瓣膜性心房颤动患者左心房内血栓形成的关系。方法按照经食管超声心动图（TEE）检查结果将非瓣膜性心房颤动患者98名分为：左心房血栓形成组（血栓组）22例、无左心房血栓形成组（非血栓组）76例。检测血浆中C反应蛋白、D-二聚体的浓度及经胸超声心动图检测左心房直径、射血分数。结果血栓组在C反应蛋白浓度、D-二聚体浓度、左心房直径、射血分数、缩短分数方面与非血栓组差异有统计学意义,分别为C反应蛋白浓度（中位数1.60mg/L比0.80 mg/L,P=0.003）、D-二聚体浓度（中位数170.50μg/L比92.00μg/L,P=0.004）、左心房直径（55.20±12.94 mm比46.77±12.31 mm,P=0.002）、射血分数（57.46%±9.10%比62.81%±8.67%,P=0.006）、缩短分数（29.82%±5.26%比35.24%±5.41%,P〈0.001）。Logistic回归,发现C反应蛋白、左心房直径与非瓣膜性心房颤动合并血栓形成独立相关（P〈0.05）,而D-二聚体、射血分数、缩短分数与非瓣膜性心房颤动合并血栓形成无显著相关。结论CRP增高、左心房直径扩大是非瓣膜性心房颤动合并血栓形成的高危因素,炎症反应可能参与了心房内血栓的形成。     

Cognitive function and adherence to anticoagulation treatment in patients with atrial fibrillation

Background Medication adherence is an integral part of the comprehensive care of patients with atrial fibrillation (AF) receiving oral anticoagulation (OACs) therapy. Many patients with AF are elderly and may suffer from some form of cognitive impairment. This study was conducted to investigate whether cognitive impairment affects the level of adherence to anticoagulation treatment in AF patients. Methods The study involved 111 AF patients (mean age, 73.5 ± 8.3 years) treated with OAC. Cognitive function was assessed using the Mini Mental State Examination (MMSE). The level of adherence was assessed by the 8-item Morisky Medication Adherence Scale (MMAS-8). Scores on the MMAS-8 range from 0 to 8, with scores < 6 reflecting low adherence, 6 to < 8 medium adherence, and 8 high adherence. Results 46.9% of AF patients had low adherence, 18.8% had moderate adherence, and 33.3% had high adherence to OAC. Patients with lower adherence were older than those with moderate or high adherence (76.6 ± 8.7 vs. 71.3 ± 6.4 vs. 71.1 ± 6.7 years) and obtained low MMSE scores, indicating cognitive disorders or dementia (MMSE = 22.3 ± 4.2). Patients with moderate or high adherence obtained high MMSE test results (27.5 ± 1.7 and 27.5 ± 3.6). According to Spearman’s rank correlation, worse adherence to treatment with OAC was determined by older age (rS = －0.372) and lower MMSE scores (rS = 0.717). According to multivariate regression analysis, the level of cognitive function was a significant independent predictor of adherence (b = 1.139). Conclusions Cognitive impairment is an independent determinant of compliance with pharmacological therapy in elderly patients with AF. Lower adherence, beyond the assessment of cognitive function, is related to the age of patients.     

Anticoagulation in women with non-valvular atrial fibrillation in the stroke prevention using an oral thrombin inhibitor (SPORTIF) trials.

AIMS: The risk of stroke is greater among women with atrial fibrillation (AF) than men. Warfarin protects against stroke, but treatment-related bleeding occurs more often in women than in men. METHODS AND RESULTS: SPORTIF III (open label, n=3410) and V (double-blind, n=3922) included 2257 women with AF and one or more stroke risk factors randomized to warfarin [target international normalized ratio (INR) 2.0-3.0] or ximelagatran (36 mg twice daily). Primary outcomes were all stroke (ischaemic/haemorrhagic) and systemic embolic event. Women were older, on average, than men, 73.4+/-8.0 vs. 69.8+/-9.0 years (P<0.0001). More women were >75-years old and women had more risk factors than men had (P<0.0001). The INR on warfarin (mean 2.5+/-0.7) was within target range for 67% of follow-up regardless of gender. Women more often developed primary events [2.08%/year, 95% confidence interval (CI) 1.60-2.56%/year vs. 1.44%/year, 95% CI 1.18-1.71%/year in men; P=0.016). Major bleeding rates were similar (P=0.766) but women experienced more overall (major/minor) bleeding (P<0.001). Warfarin was associated with more overall bleeding in both genders and more major bleeding in women than in men (P=0.001). CONCLUSION: When compared with men with AF, women in these studies were older and had more stroke risk factors. Women were more prone to anticoagulant-related bleeding; the higher rate of thrombo-embolism among women was related to more frequent interruption of anticoagulant therapy.     

Frontiers of anticoagulation therapy for atrial fibrillation

In the management of atrial fibrillation (AF), stroke prevention has been proved to play a pivotal role in addition to therapy for concomitant diseases. And, hitherto, anticoagulation by warfarin has been the only effective choice that is known to decrease the stroke rate with ～70% risk reduction. Although the evidence has been rigid, there are many barriers not to make warfarin therapy pervasive. However, the principle of "KISS (keep it short and simple)" seems to alter our situations. Changing the complex pharmacology with warfarin into the simple pharmacology with new anticoagulants would lead us to a new paradigm, where the old book is now rewritten by a new language.     

Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation?

AIMS: To assess the relation between the atrial fibrillation (AF) subtype and thrombo-embolic events. METHODS AND RESULTS: The observational Euro Heart Survey on AF (2003-04) enrolled 1509 paroxysmal, 1109 persistent, and 1515 permanent AF patients, according to the 2001 American College of Cardiology, American Heart Association, and the European Society of Cardiology guidelines definitions. A 1 year follow-up was performed. Permanent AF patients had at baseline a worse stroke risk profile than paroxysmal and persistent AF patients. In paroxysmal AF, the risk for stroke, any thrombo-embolism, major bleeding and the combined endpoint of cardiovascular mortality, any thrombo-embolism, and major bleeding was comparable with persistent and permanent AF, in both univariable and multivariable analyses. Compared with AF patients without stroke, patients suffering from a stroke had a comparable frequency and duration of AF attacks, but tended to have a worse stroke risk profile at baseline. During 1 year following cardioversion, paroxysmal AF patients had a higher risk for stroke (P = 0.029) and any thrombo-embolism (P = 0.001) than persistent AF patients. CONCLUSION: In the Euro Heart Survey, paroxysmal AF had a comparable risk for thrombo-embolic events as persistent and permanent AF. This observation strengthens the guideline recommendation not to consider the clinical AF subtype when deciding on anticoagulation.