老年非瓣膜性心房颤动合并缺血性脑血管病住院患者抗凝治疗研究

目的:本研究回顾性调查老年非瓣膜性心房颤动(NVAF)合并缺血性脑血管病缺血性脑卒中和短暂性脑缺血发作(TIA)]的住院患者抗凝治疗实际应用情况。方法:选择出院诊断为NVAF合并缺血性脑卒中/TIA的老年住院患者626例,应用CHA2DS2-VASc评分评估脑卒中危险,结合CHA2DS2-VASc评分调查各分层的住院期间抗凝治疗情况,并按年龄分为非高龄组(65~74岁,n=316)和高龄组(≥75岁,n=310),比较两组的抗凝治疗情况。结果:626例老年NVAF合并缺血性脑卒中/TIA患者CHA2DS2-VASc评分均>2分,平均(5.48±1.27)分,其中仅35.3%使用口服抗凝药物治疗,而51.6%使用抗血小板治疗,13.1%未使用上述两种药物治疗,高龄组的患者抗凝比例明显小于非高龄组的患者(28.4%vs.42.1%,P<0.001)。结论:本研究结果提示老年NVAF合并缺血性脑卒中/TIA住院患者抗凝治疗比例偏低,应使用指南推荐的CHA2DS2-VASc评分制定抗凝策略以提高抗凝比例。

Study on anticoagulant therapy of elderly hospitalized patients with nonvalvular atrial fibrillation and ischemic stroke/TIA

Objective: To investigate the application of anticoagulant therapy in elderly hospitalized patients with non-valvular atrial fibrillation( NVAF) and ischemic stroke / TIA retrospectively. Methods: A total of626 elderly hospitalized patients,who met the discharge diagnostic criteria for NVAF and ischemic stroke / TIA were included in this study. Evaluated stroke risk stratification by CHA2DS2-VASc scores and investigated the anticoagulant therapy information. According to the age,the patients were divided into non-very elderly group( 65- 74 y,n = 316) and very elderly group( ≥75y,n = 310),and compared the anticoagulant therapy between the two groups. Results: In the 626 elderly patients diagnosed with NVAF and ischemic stroke / TIA,the mean ±SD of CHA2DS2-VASc score was( 5. 48 ± 1. 27),35. 3% of those patients received anticoagulant therapy,whereas 51. 6% of those received antiplatelet therapy,13. 1% of those did not use of the two kinds of drugs.The proportion of anticoagulant therapy of very elderly group were significantly lower than that in the non-very elderly group( 28. 4% vs. 42. 1%,P < 0. 001). Conclusion: In elderly hospitalized patients with NVAF and Ischemic Stroke / TIA,the use of anticoagulant therapy was insufficient. And we should use the CHA2DS2-VASc scores recommended by guidelines to make the anticoagulant therapy strategy to improve the proportion of anticoagulant therapy.