75岁以上老年非瓣膜病心房颤动患者抗血栓治疗的应用现状

目的对于我院>75岁老年非瓣膜病心房颤动(房颤)患者抗血栓药物治疗的情况进行调查,了解用药现状。方法调查>75岁非瓣膜病房颤患者125例,对其危险因素及抗血栓药物使用情况进行分析。结果125例患者中,合并多种危险因素者多见,其中应用华法林者只有30例(24.0%),应用阿司匹林者54例(43.2%),其他抗血小板药物29例(23.2%),未应用抗血栓药物12例(9.6%)。阿司匹林及其他抗血小板口服药剂量为每天75~100 mg。结论>75岁老年非瓣膜病房颤患者华法林应用率低,抗血小板药使用率高,但用药剂量偏小。     

老年心房颤动高危患者抗凝治疗的药物选择及安全性

目的探讨老年心房颤动患者抗凝治疗的药物剂量选择及安全性。方法选择确诊的老年心房颤动患者210例,按照年龄将60～79岁130例作为老年段及≥80岁80例作为高龄段。2个年龄段患者按服药治疗不同分为老年华法林组30例、高龄华法林组30例,老年联合用药组50例(氯吡格雷75 mg+阿司匹林100 mg),老年阿司匹林组50例和高龄阿司匹林组50例(阿司匹林100 mg)。观察服用华法林剂量及国际标准化比值(INR);各组患者栓塞及出血发生率。结果高龄华法林组剂量(2.88±0.46)mg,INR 2.29±0.55,老年华法林组剂量(2.93±0.75)mg,INR 2.30±0.52,差异无统计学意义(P>0.05)。老年华法林组和高龄华法林组及老年联合用药组栓塞发生率明显低于老年阿司匹林组和高龄阿司匹林组(P<0.05)。与老年华法林组和高龄华法林组及老年阿司匹林组和高龄阿司匹林组比较,老年联合用药组出血发生率明显高(P<0.05)。结论老年心房颤动患者服用华法林或氯吡格雷+阿司匹林能更有效预防脑卒中事件的发生,老年、尤其是高龄高危患者服用华法林治疗,INR控制在1.5～2.5是安全、有效。对于不适合应用华法林的患者,可应用氯吡格雷+阿司匹林预防血栓形成。     

高龄非瓣膜病心房颤动患者抗栓治疗调查

目的调查华东医院心内科≥80岁非瓣膜病心房颤动患者临床特征及抗血栓药物治疗的情况,了解用药现状。方法调查≥80岁非瓣膜病房颤患者84例,对其危险因素等临床特征及抗血栓药物使用情况进行分析。结果非瓣膜性房颤的病因以冠心病、高血压病、肺源性心脏病、甲状腺功能亢进、孤立性房颤及扩张型心肌病为主。84例患者中,绝大多数合并多种危险因素,其中应用华法林者只有6例（7．1％）,应用阿司匹林者56例（66．7％）,其他抗血小板药物7例（8．3％）,未应用抗血栓药物15例（17．9％）。结论高龄非瓣膜病房颤患者华法林应用率低,抗血小板药使用率高。     

142例心房颤动住院患者华法林使用情况的回顾性分析

目的回顾分析心房颤动住院患者华法林抗凝情况,初步探讨基层医院心房颤动患者的华法林治疗现状。方法选择2006年—2007年住院的心房颤动患者142例,全面收集患者血栓栓塞的高危因素、抗凝禁忌症,华法林的用法、用量,以及未用华法林的原因等。结果房颤患者总体接受抗栓治疗（华法林或阿司匹林）者85.28%,其中华法林治疗61.97%,〈65岁组华法林治疗66.19%,65岁～75岁组华法林治疗71.69%,〈75岁组华法林治疗仅16.67%;高危组华法林治疗71.3%,中危组华法林治疗46.7%,低危组华法林治疗为零。结论住院以房颤动患者总体接受华法林抗凝治疗的情况较好,但〉75岁高、中危的老年房颤患者抗凝治疗不足,加强医生对华法林抗凝的认识以及采用更方便安全有效的抗凝新药可能会进一步提高老年患者的抗凝治疗。     

老年非瓣膜病性心房纤颤患者抗血栓治疗现状分析

目的分析空军总医院老年非瓣膜病性心房纤颤（NVAF）患者抗血栓药物治疗现状及未抗凝治疗的原因。方法调查老年NVAF患者109例,对其病因、血栓栓塞危险因素、抗血栓药物应用情况及未应用华法林抗凝治疗原因进行分析。应用CHADS卒中风险评分表对NVAF患者进行血栓栓塞危险评估。结果91.6%患者接受了抗血栓治疗。符合抗凝治疗指征患者68例,仅38.2%接受了华法林治疗,57.4%进行了抗血小板治疗阿司匹林剂量为（87±15）mg/d,4.4%未进行任何抗血栓治疗。而其中NVAF呈阵发性者仅5.0%应用了华法林抗凝治疗。未抗凝治疗者54例,其中存在抗凝禁忌证12例（15.0%）;严重出血而停用1例（1.3%）,不能凝血监测2例（2.5%）;担心出血拒绝8例（10.0%）;阵发性心房纤颤未抗凝治疗20例（25.0%）;冠脉支架术后双重抗血小板治疗而未抗凝治疗3例（3.75%）;原因不明9例（11.3%）。结论老年NVAF患者抗血栓治疗中华法林应用率低,而且阵发性心房纤颤的华法林应用率更低,抗血小板治疗中阿司匹林剂量不足。     

华法林治疗非瓣膜性心房颤动并发血栓栓塞的随机对照研究

目的比较华法林、阿司匹林及复方丹参滴丸对非瓣膜性心房颤动(NVAF)的抗血栓栓塞的疗效和不良反应.方法 NVAF病人100例,其中华法林组40例,予华法林2.0 mg/d～6.5mg/d;阿司匹林组30例,予75 mgg/～150 mg/d;复方丹参滴丸组30例,予30 g/d,所有病人均给予基础疾病治疗,随访2年,以脑卒中发病率作为疗效判定依据.结果华法林组脑卒中发病率5.0%,阿司匹林组为16.7%,复方丹参滴丸组为23.3%.华法林组有1例出现小量脑出血,阿司匹林组有5例出现上腹痛、恶心.结论华法林对NVAF的抗血栓治疗疗效确切,且副反应不明显.     

华法林两种抗凝方案治疗阵发性房颤的临床疗效与安全性分析

目的探讨阵发性房颤患者采用华法林两种抗凝方案治疗的有效性与安全性。方法选择76例阵发性房颤患者,按住院编号的奇偶分为观察组和对照组,每组38例,其中观察组长期服用华法林,对照组短期服用华法林,对比分析两组患者治疗效果及不良反应发生率。结果观察组脑梗死发生率、出血性并发症发生率均为7.9%,对照组均为5.26%,两组比较差异无统计学意义(P0.05);两组患者药物不良反应发生率比较差异无统计学意义(P0.05)。结论短期服用华法林抗凝方案在防控阵发性房颤脑梗死、出血并发症等方面效果与长期服用华法林抗凝治疗方案效果相当。     

70岁以上心房颤动患者109例抗栓治疗分析

目的分析70岁以上老年心房颤动(房颤)患者治疗情况,探讨老年房颤患者抗栓治疗策略、疗效、安全性和影响因素。方法 70岁以上老年房颤患者109例,按年龄分为3组:70～79岁组(22例),80～89岁组(70例),90岁以上组(17例),回顾性分析治疗疗效、安全性和影响因素。结果所有患者中,抗栓治疗81例。单用阿司匹林30例,单用氯吡格雷34例,阿司匹林合用氯吡格雷11例,使用华法林抗凝治疗6例。70～79岁组抗血小板治疗20例(90.9%),抗凝治疗1例(4.5%);80～89岁组抗血小板治疗43例(61.4%),抗凝治疗4例(5.7%);90岁以上组抗血小板治疗12例(70.6%),抗凝治疗1例(5.9%)。房颤并存肿瘤者24例(22.0%)。既往发牛过十二指肠球部溃疡、出血性胃炎或血小板减少等出血性疾病又发生过深静脉血栓或腔隙性脑梗死等缺血性疾病的患者10例(9.2%)。抗血小板治疗中发牛深静脉栓塞、心房血栓等患者4例(5.3%),治疗后发生胃肠道出血者2例(2.7%),抗凝治疗后发生胃肠道出血、恼出血者各1例(33.3%)。结论高龄老年房颤患者抗栓治疗不充分,且存在多种复杂的病理生理状态,导致了高血栓危险和高出血风险。     

阵发性房颤两种抗凝方案的疗效和安全性的对比研究

目的分析探讨阵发性房颤采用华法林两种抗凝方案治疗的有效性与安全性。方法选取182例阵发性房颤患者作为研究对象,不用或短暂服用华法林抗凝组88例,长期服用华法林抗凝组94例,比较两组治疗效果。结果两组都观察随访1年以上发现:不用或短暂服用华法林抗凝组新发有症状的脑梗塞发生率为2.27%,出血性并发症发生率为2.27%;长期服用华法林抗凝组新发有症状的脑梗塞发生率为2.13%;出血性并发症发生率为3.19%;两组脑梗塞、出血并发症发生情况比较无统计学意义(P0.05)。结论不用或短暂服用华法林抗凝方案在防控阵发性房颤脑梗塞、出血并发症等方面效果与长期服用华法林抗凝方案效果相近,有效性与安全性均有保证,值得推广应用。     

206例老年心房颤动患者抗栓治疗及血管事件发生情况5年随访

目的分析老年心房颤动(房颤)患者近5年抗栓治疗现状及血管事件发生情况。方法回顾性分析2005年1月～2006年6月入住我院的年龄≥75岁房颤患者206例,记录主要合并疾病、抗栓治疗方法及5年内栓塞、严重出血及死亡事件发生情况。结果 206例房颤患者中共发生栓塞事件47次,年发生率为4.56%。严重出血事件3次,年发生率为0.29%。行阿司匹林抗血小板治疗70例,氯吡格雷治疗66例,氯吡格雷联合阿司匹林抗血小板治疗11例,未行抗栓治疗56例。行华法林抗凝治疗3例,随访期间更换为抗凝治疗11例。抗凝时间平均2年1个月。结论老年房颤患者栓塞事件年发生率高,预防栓塞具有重要的临床意义。华法林抗凝治疗率低,抗凝治疗时间短。     

The impact of age on antithrombotic use in elderly patients with non‐valvular atrial fibrillation

Aim of study: To investigate the use of antithrombotic therapy in elderly patients with atrial fibrillation (AF). Methods: Data were collected retrospectively from the medical records of 262 AF patients >65 years, who were admitted to a Sydney teaching hospital over a 12‐month period. Results: Overall, 202 (79%) patients were discharged on some antithrombotic therapy. Patients <80 years were as likely to receive antithrombotic therapy as those <80 years (75.8% versus 81.9%, P=0.23), but a significantly lower proportion received warfarin than did those <80 years (25.5% versus 61.5%, P < 0.0001). Definite contraindications to anticoagulation were a significant influence on antithrombotic agent selection (P=0.04), but multivariate analysis indicated that ‘old age’ was the largest contributing factor: patients >80 years were 5.46 times more likely to receive aspirin in preference to warfarin than their younger counterparts (P<0.0001). Conclusion: Warfarin is being withheld in AF patients ≥80 years for reasons other than recognised contraindications and is, therefore, potentially underutilised in the target elderly population. Further studies are necessary to determine whether this is appropriate.     

Newly detected atrial fibrillation and compliance with antithrombotic guidelines

BACKGROUND: Guidelines recommend the use of antithrombotic therapy for stroke prevention in patients with atrial fibrillation (AF), but compliance with such guidelines has not been widely studied among patients with newly detected AF. Our objective was to assess compliance with antithrombotic guidelines and to identify patient characteristics associated with warfarin use. METHODS: A population-based study of newly detected AF (patient age, 30-84 years) was conducted within a large health plan. Cardiovascular disease risk factors, comorbid conditions, medication use, and international normalized ratios were abstracted from the medical record. Patients were stratified by embolic risk according to American College of Chest Physicians (ACCP) criteria. We analyzed the proportion of patients with AF receiving warfarin or aspirin (> or =325 mg/d) during the 6 months following AF. Relative risk regression estimated the association of risk factors and patient characteristics with warfarin use. RESULTS: Overall, 73% of patients (418/572) with newly detected AF had evidence of antithrombotic use after AF onset. Among the 76% (437/572) of patients with AF at high risk for stroke, 59% (257/437) used warfarin, 28% (123/437) used aspirin, and 24% (104/437) used neither. The major predictor of warfarin use was AF classification; intermittent or sustained AF had relative risks for warfarin use of 2.8 (95% confidence interval, 2.2-3.6) and 2.9 (95% confidence interval, 2.2-3.7), respectively, compared with transitory AF. CONCLUSIONS: Three quarters of the patients with newly detected AF received antithrombotic therapy, yet many at high risk of stroke did not receive warfarin. Atrial fibrillation classification, rather than stroke risk factors, was strongly associated with warfarin use.     

心房颤动患者危险分层后抗凝治疗的临床研究

目的根据CHADS2评分对心房颤动（房颤）患者进行危险分层,探讨口服阿司匹林抗凝治疗与口服华法林抗栓治疗预防缺血性脑卒中的临床效果。方法对82例非瓣膜病房颤患者根据CHADS2评分进行分组,抗凝周期均大于6个月,其中40例评分〈2的患者口服阿司匹林（1组）,评分≥2的患者中25例口服阿司匹林（2组）抗凝,17例口服华法林抗栓,分别随访是否有缺血性脑卒中、死亡及主要出血事件的发生。结果1组1例发生缺血性脑卒中,2组发生缺血性脑卒中5例,口服华法林治疗组无缺血性脑卒中发生,1例胃出血。结论根据CHADS2评分进行危险分层后,1组抗凝治疗安全有效,而2组抗凝治疗较口服华法林抗栓治疗不能有效地预防缺血性脑卒中的发生。     

Prothrombin fragment F1 + 2 and thrombin-antithrombin III complex are useful markers of the hypercoagulable state in atrial fibrillation.

It is well known that atrial fibrillation (AF) is one of the most important diseases that predispose patients to thrombosis. We have attempted to identify patients with AF in the hypercoagulable state by measuring molecular markers such as thrombin-antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (PTF) and determining the effect of antithrombotic therapy on these markers; 83 patients with AF were studied. Increased levels of plasma TAT and PTF were more frequently observed in patients with AF and associated mitral stenosis than in patients with AF alone. In cases of AF without mitral stenosis, plasma levels of TAT and PTF were significantly lower in those patients receiving antithrombotic agents (aspirin or warfarin) than in those receiving no antithrombotic agents. Furthermore, plasma levels of PTF were significantly lower in patients given warfarin than in those receiving aspirin. These results suggest that (1) patients with AF and mitral stenosis who are not given warfarin are in an extremely hypercoagulable state and (2) some patients with AF without mitral stenosis who are not given antithrombotic agents are also moderately hypercoagulable. In vivo activation of blood coagulation was more effectively controlled in patients receiving warfarin than in those taking aspirin.     

Balancing the risks of stroke and upper gastrointestinal tract bleeding in older patients with atrial fibrillation

OBJECTIVE: To determine how factors that increase the risk of major upper gastrointestinal (GI) tract hemorrhage (recent upper GI tract bleeding or concurrent use of nonsteroidal anti-inflammatory drugs) influence the choice of antithrombotic therapy in older patients (those > or = 65 years) with atrial fibrillation. METHODS: For older patients with atrial fibrillation and no other contraindications to antithrombotic therapy, a Markov decision-analytic model was used to determine the preferred treatment strategy (no antithrombotic therapy, long-term aspirin use, or long-term warfarin sodium use) based on their risk of major upper GI tract hemorrhage. Input data were obtained by a systematic review of MEDLINE. Outcomes were expressed as quality-adjusted life-years (QALYs). RESULTS: For 65-year-old patients with average risks of stroke and upper GI tract bleeding, warfarin therapy was associated with 12.1 QALYs per patient; aspirin therapy, 10.8 QALYs; and no antithrombotic therapy, 10.1 QALYs. For persons with significantly higher risks of upper GI tract bleeding and/or lower risks of stroke, warfarin was no longer clearly the optimal antithrombotic therapy (eg, for 80-year-old persons with a baseline risk of stroke of 4.3% per year who were concurrently taking a conventional nonsteroidal anti-inflammatory drug: warfarin, 7.44 QALYs; aspirin, 7.39 QALYs; and no treatment, 7.21 QALYs). CONCLUSIONS: For older patients with atrial fibrillation and factors that place them at a higher than average risk of upper GI tract bleeding, the optimal choice of antithrombotic therapy to prevent stroke can vary according to the magnitude of this risk. Based on the risks of stroke and upper GI tract bleeding, clinicians can use the treatment recommendations of this study to provide rational stroke prevention therapy for older patients with atrial fibrillation.