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中国非瓣膜性心房颤动患者华法林使用不足的相关因素分析
引用本文:王春娟,王春雪,王拥军,王伊龙,赵性泉,刘丽萍,David Z.Wang,李昊,杨中华.中国非瓣膜性心房颤动患者华法林使用不足的相关因素分析[J].中国新药杂志,2012(11):1203-1209.
作者姓名:王春娟  王春雪  王拥军  王伊龙  赵性泉  刘丽萍  David Z.Wang  李昊  杨中华
作者单位:首都医科大学附属北京天坛医院神经内科;美国伊利诺伊大学医学院伊利诺伊卒中中心与卒中网
基金项目:国家“重大新药创制”科技重大专项(2008ZX09312-008);卫生部卫生公益行业科研专项(200902004);“十二五”国家科技支撑计划重大项目(2011BAI08B02)
摘    要:目的:评估中国首发缺血性卒中或短暂性脑缺血发作(TIA)的已知非瓣膜性心房颤动(NVAF)患者华法林的使用情况及使用不足的相关因素。方法:从中国国家卒中登记数据库(CNSR)中连续筛选首发缺血性卒中或TIA的NVAF患者,筛选已知心房颤动和新发心房颤动患者,评估华法林在适合抗凝治疗的已知心房颤动患者中的使用比例。采用多变量logistic回归模型评估华法林使用不足的相关因素。结果:在筛选出的11 080例首发缺血性卒中或TIA患者中,有996例(9.7%)患者存在NVAF且无抗凝治疗禁忌症,其中有592例既往已知存在心房颤动。在这些患者中,只有96例(16.2%)发病前服用了华法林,496例(83.8%)发病前未服用华法林。在服用华法林的患者中,只有1例患者入院时的国际标准化比值(INR)在治疗范围(2.0~3.0)内。依据CHADS2卒中风险评分,在卒中发生前的低危心房颤动患者中,有近20.2%的患者服用了华法林,而在中危及高危患者中,华法林的服用比例分别只有15.2%和16.4%。年老的和既往存在冠心病病史的患者服用华法林的可能性较小,而发病前服用抗血小板药物的患者更有可能服用华法林。结论:CNSR中首发缺血性卒中或TIA的NVAF患者中,适宜抗凝治疗的患者存在严重的华法林使用不足,即使接受抗凝治疗,达标率也极低。如果发病前给予合适的抗凝治疗并监测,许多由心房颤动导致的卒中和TIA就可避免。

关 键 词:首发卒中  心房颤动  抗凝治疗  华法林  抗栓治疗

Analysis of significant under-usage of warfarin in patients with nonvalvular atrial fibrillation
WANG Chun-juan,WANG Chun-xue,WANG Yong-jun,WANG Yi-long,ZHAO Xing-quan,LIU Li-ping,WANG David Z.,LI Hao,YANG Zhong-hua.Analysis of significant under-usage of warfarin in patients with nonvalvular atrial fibrillation[J].Chinese Journal of New Drugs,2012(11):1203-1209.
Authors:WANG Chun-juan  WANG Chun-xue  WANG Yong-jun  WANG Yi-long  ZHAO Xing-quan  LIU Li-ping  WANG David Z  LI Hao  YANG Zhong-hua
Institution:1(1 Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;2 INI Stroke Center & Stroke Network,OSF Healthcare System,University of Illinois College of Medicine,Peoria 61605,USA)
Abstract:Objective: To examine the current state of warfarin usage in nonvalvular atrial fibrillation(NVAF) patients with first-ever ischemic stroke(IS) or transient ischemic attack(TIA) in China,and to analyze the factors causing such under-usage.Methods: By accessing the China National Stroke Registry(CNSR),data on consecutive patients with known NVAF who developed first-ever IS or TIA was studied.Proportion of warfarin usage was estimated in those patients with known NVAF who should be eligible for anticoagulation therapy.Factors associated to warfarin under-usage were identified by multivariate logistic regression.Results: Of 11 080 patients with first-ever IS or TIA,996(9.7%) had NVAF and no contraindications to anticoagulation therapy and 592 of them had history of AF.Among these patients,only 96(16.2%) were on warfarin and 496(83.8%) were not.In those patients on warfarin,only 1 of his International Normalized Ratios(INRs) on admission was in the therapeutic range of 2.0~3.0.Based on the CHADS2 scores,about 20.2% low risk AF patients took warfarin,however,only 15.2% moderate and 16.4% high risk patients were on warfarin.Older patients and patients with history of coronary heart disease(CHD) were less likely to be given warfarin,while patients with history of pre-stroke antiplatelet usage were more likely to take warfarin.Conclusion: Warfarin has been significantly under-used in patients with known NVAF in China.Many strokes and TIAs caused by AF could have been prevented if warfarin was appropriately prescribed and monitored.
Keywords:first-ever stroke  atrial fibrillation  anticoagulation  warfarin  antithrombotic therapy
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