老年非瓣膜性心房颤动患者抗凝方案及其主要不良心脑血管事件的观察性研究

目的：探讨基于不同抗凝方案的老年非瓣膜性心房颤动患者主要不良心脑血管事件发生率。方法：抽取2018年7月至2021年5月安徽中医药大学第二附属医院诊断为非瓣膜性心房颤动的65岁及以上住院患者资料，根据治疗方案分为未抗凝组、华法林组、达比加群酯组，比较3组患者一般临床资料和主要心脑血管事件发生率、1年内累积再住院率、全因死亡率，采用二元logistic回归分析发生心脑血管事件的独立危险因素。结果：共收集437例患者，其中未抗凝组88例（20.14%）、华法林组157例（35.93%）、达比加群酯组192例（43.93%），抗凝率79.86%。与未抗凝组相比，华法林组和达比加群酯组能显著降低1年内再住院率（80.70%vs.42.00%vs.22.90%，P<0.05）、心血管事件发生率（52.27%vs.22.29%vs.9.90%，P<0.05）、全因死亡率（12.50%vs.3.82%vs.0.52%，P<0.05）以及脑血管事件发生率（23.86%vs.7.01%vs.4.17%，P<0.05）；与未抗凝组和达比加群酯组相比，华法林组显著增加小出血事件发生率（12.50%vs.21.02%vs.10.42%，P<0.05），达比加群酯较华法林能进一步降低1年内再住院率和累积心血管事件发生率（P<0.05）。多因素二元logistic回归分析提示未抗凝治疗（0.371，95% CI：0.210~0.655，P=0.001）以及出血史（0.101，95% CI：0.032~0.319，P<0.01）是1年内主要不良心脑血管事件的独立危险因素，服用达比加群酯（2.908，95% CI：1.565~5.404，P=0.001）是保护因素。结论：老年非瓣膜性心房颤动患者存在抗凝不足，抗凝治疗可降低主要不良心脑血管事件发生率及全因死亡率，临床医师和临床药师应促进抗凝治疗规范化及个体化。

An observational study on anticoagulant regimen and major adverse cardiovascular and cerebrovascular events in elderly patients with non-valvular atrial fibrillation

OBJECTIVE To investigate the incidence of major adverse cardiovascular and cerebrovascular events in elderly patients with non-valvular atrial fibrillation based on different anticoagulant regiments.METHODS Patients over 65 years old who were diagnosed with non-valvular atrial fibrillation in the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine from July 2018 to May 2021 were selected and divided into non-anticoagulant group, warfarin group and dabigatran group according to therapeutic schemes.The general clinical data, the incidence of major cardiovascular and cerebrovascular events, the cumulative rehospitalization rate within one year and the all-cause mortality of patients were compared among the three groups.Binary logistic regression was used to analyze the independent risk factors of cardiovascular and cerebrovascular events.RESULTS A total of 437 patients were collected, including 88 cases (20.14%) in the non-anticoagulant group, 157 cases (35.93%) in the warfarin group and 192 cases (43.93%) in the dabigatran group, with an anticoagulant rate of 79.86%.Compared with the non-anticoagulant group, warfarin group and dabigatran group significantly reduced 1-year rehospitalization rate (80.70% vs.42.00% vs.22.90%, P<0.05), cardiovascular event rate (52.27% vs.22.29% vs.9.90%, P<0.05), all-cause mortality (12.50% vs.3.82% vs.0.52%, P<0.05) and incidence of cerebrovascular events (23.86% vs.7.01% vs.4.17%, P<0.05);compared with the non-anticoagulant group and dabigatran group, warfarin group significantly increased the incidence of minor bleeding events (12.50% vs.21.02% vs.10.42%, P<0.05);compared with warfarin, dabigatran axetil can further reduce the rehospitalization rate and cumulative incidence of cardiovascular events within one year (P<0.05).Multivariate binary logistic regression analysis indicated no anticoagulant treatment (0.371, 95%CI:0.210-0.655, P=0.001) and bleeding history (0.101, 95%CI:0.032-0.319, P<0.01) were independent risk factors for the occurrence of major cardiovascular and cerebrovascular events within 1 year, and anticoagulant treatment with dabigatran (2.908, 95%CI:1.565-5.404, P=0.001) was its protective factor.CONCLUSION The elderly patients with non-valvular atrial fibrillation in our hospital have insufficient anticoagulation, and anticoagulation treatment can reduce the incidence of major cardiovascular events and all-cause mortality within one year.Clinicians and clinical pharmacists should promote the standardization and individualization of anticoagulation treatment.