老年非瓣膜性心房颤动抗凝治疗现状分析

目的分析影响老年非瓣膜性心房颤动患者抗凝治疗的因素,为提高老年心房颤动患者抗凝治疗寻求解决方法。方法对2009-10-01—2010-04-30入住北京协和医院,年龄≥65岁的老年非瓣膜性心房颤动患者进行门诊及电话随访,观察分析全因死亡、抗凝比例、未选择抗凝的原因、抗凝终止的原因、不抗凝(抗凝终止)后的抗栓方法等指标。结果共70例连续入院的患者纳入研究,平均随访9.1个月(6.0~13.5个月)。有效随访63例,其中包括年龄<75岁组33例和年龄≥75岁组30例。失访7例(10%)。随访期间共8例(12.7%)死亡,包括年龄<75岁组1例(3%)和年龄≥75岁组7例(23.3%)。有效随访病例中,进行抗凝治疗的仅16例(25.4%),这16例中INR达标13例。8例死亡患者均未进行抗凝治疗,其中6例称大夫未交待抗凝,另2例有明确抗凝禁忌证。结论老年心房颤动患者抗凝比例低,有效抗凝率低。抗凝过程中中断的比例高。解决老年心房颤动患者抗凝过程的具体困难是有效治疗的关键。

The current status of anticoagulation therapy in elderly patients with nonvalvular atrial fibrillation

Objective To investigate the factors affecting anticoagulation therapy in elderly patients with nonvalvular atrial fibrillation and to explore the resolutions for improvement of anticoagulation therapy.Methods Between October 1,2009 and April 30,2010,in-patients aged≥65 years with nonvalvular atrial fibrillation in Peking Union Medical College Hospital were recruited and performed out-patient and telephone follow-ups for observation and analysis of indexes such as all-cause mortality;the ratio of anticoagulation;the reasons for unselected anticoagulation and the reasons for termination of anticoagulation and antithrombotic methods for patients with no anticoagulation(termination of anticoagulation).Results A total of 70 in-patients were recruited in the study(mean=9.1 months,range from 6.0 to 13.5 months).Notably,63 cases were effective including group aged<75 years(n=33) and group aged≥75 years(n=30),with 7 cases lost to follow-up.In the follow-up,eight patients(12.7%) died including 1(3%) in group aged<75 years and 7 in group aged≥75 years(23.3%).For the effective cases in follow-up,only 16 out of 63 patients were performed anticoagulation therapy(25.4%),among whom 13 patients met the INR standard.For 8 death patients with no anticoagulation therapy,6 cases were reported no anticoagulation therapy transferred by the doctors,and the reaming 2 patients had definite contraindications to anticoagulation therapy.Conclusion The elderly patients with nonvalvular atrial fibrillation had a low ratio of anticoagulation,a low effective anticoagulation rate and a high discontinuation rate in anticoagulation process.Therefore,it is crucial to solve practical difficulties in effective treatment of elderly patients with nonvalvular atrial fibrillation in anticoagulation process.