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。

Investigation of anti-thrombotic therapy in elderly patients over 70 years old with atrial fibrillation:report of 109 cases

Objective To investigate anti-thrombotic therapy on atrial fibrillation （AF） of elderly patients over 70 years old, including the therapeutic strategy, effect, safety and impact factors. Methods A total of 109 elderly patients with AF were analyzed retrospectively. They were divided into 3 groups by age ： age 70 to 79 （ n = 22 ）, age 80 to 89 （ n = 70）, age over 90 （ n = 17 ）. Results Among all patients, 81 cases were treated with anti-thrombotic drugs. Thirty patients were prescribed with aspirin （ASA） alone; 34 patients with clopidogrel （CPG） alone; 11 patients with ASP plus CPG; 6 patients with warfarin. Patients aged 70 to 79 with antiplatelet agents accounted for 90. 9%, while those with anticoagulant drug only 4. 5% ; Patients aged 80 to 89 with antiplatelet agents 61.4%, while those with anticoagulant drug 5.7% ; Patients aged over 90 with antiplatelet agents 70. 6% , while those with anticoagulant drug 5.9%. There were 24 cases （22. 0% ） with cancer. There were 10 patients （9. 2% ） with hemorrtlagic diseases （duodenal ulcer, hemorrhagic gastritis, thrombocytopenia, etc） as well as ischemic diseases （deep vein thrombosis, lacunar cerebral infarction, etc）. In patients received antiplatelet therapy, ischemic events occurred in 4 cases （5.3%）, while in patients initially treated with warfarin, the rate of bleeding events occurred in 2 cases （33. 3% ）. Conclusions In elderly patients with AF, antithrombotic therapy is insufficient and the severe bleeding rate is high during anticoagulant therapy. The coexisted complicated pathophysiologic state of AF in elderly patients leads to high risk of thrombosis and bleeding events.