持续性心房颤动患者116例抗栓治疗分析

目的评估2010年6月—2011年12月我科持续性心房颤动住院患者抗栓治疗状况。方法查阅2010年6月—2011年12月我科116例持续性房颤住院患者临床资料，应用CHA：DS2-VASc评分系统评估患者卒中和血栓栓塞风险，统计患者抗栓治疗用药情况，同时应用HAS-BLED出血风险评估方案评估抗栓治疗的出血风险。结果CHA2DS2．VASc积分1分者4例，均口服阿司匹林。积分t〉2分者112例，口服阿司匹林54例（48．2％），口服华法林39例（34．8％），口服氯吡格雷＋阿司匹林8例（7．1％），口服阿司匹林＋华法林3例（2．7％），口服氯吡格雷2例（1．8％），未服抗栓药6例（5．4％）。其中口服华法林出院时INR〈1．5者14例，INR在1．5～2．0者20例，INR在2．0—3．0者8例。CHA2DS2-VASc积分≥2分，且HAS-BLED积分≥3分共45例（40．2％）。结论我科持续性房颤住院患者的抗栓治疗与指南要求尚有差距，口服抗凝治疗明显不足。血栓栓塞高发人群通常也是出血高危人群，因此抗栓治疗更应规范并谨慎监测。

Analysis on antithrombotic therapy for 116 cases of patients with persistent atrial fibrillation

Objective To analyze the treatment status of 116 cases of patients with persistent atrial fibrillation who underwent an- tithrombotie therapy in this department from June 2010 to December 2011. Methods The clinical data of 116 eases of patients with persistent atrial fibrillation who underwer/t antithrombotic therapy in this department from June 2010 to December 2011 was ret- rospectively analyzed. The CHA2DS2-VASc scoring system was used to assess the risk of stroke and thromboembolism of these pa- tients, then a statistical analysis was made ：on their antithrombotic treatment status, while applying HAS-BLED bleeding risk assess- ment program for the evaluation on bl~eedir~g risk of antithrombotic therapy. Results 4 cases had 1 point for CHA2DS2-VASc sco- ring and were orally administrated with aspirin. For 112 cases of patients with CHA2DS2-VASc score〉~ 2 points, 54 cases were orally administrated with aspirin （48.2%） ：,~ 39 cases were＂ orally administrated with warfarin （34.8%） , 8 cases were orally ad- ministrated with clopidogrel ＋ aspirin （7.1%） , 3 cases were orally administrated with aspirin ＋ warfarin （2.7%） , 2 cases were orally administrated with clopidogrel （ 1.8% ） , 6 cases didn! t receive any antithrombotic drug （5.4%）. For patients administra- ted with warfarin, 14 cases had INR 〈 1.5 at discharge, 20 cases had INR within 1.5 - 2.0, 8 cases had INR within 2.0 - 3.0. A total of 45 cases had CHA2DS2-VASe score ~〉 2 points and HAS-BLED score ~〉3 points （40.2%）. Conclusion The treat- ment status of patients with persistent atrial fibrillation who undergo anfithrombotic therapy in this department still can＇ t perfectly meet the requirements of guidance, the oral anticoagulation therapy is clearly insufficient. The patients with high risk of thromboem- bolism are usually at high risk of bleeding, so the antithrombotic therapy should be more standardized and carefully monitored.