我院心房颤动合并慢性肾脏病患者抗凝治疗状况的分析

目的：回顾性分析我院心房颤动（房颤）合并慢性肾脏病（CKD）患者的抗凝治疗状况，为提高抗凝治疗的合理性、安全性提供参考。方法：随机收集南通市第一人民医院2014年1月～2015年12月房颤合并CKD患者90例以及房颤但肾功能正常者90例的病历资料。对患者华法林使用率、抗血小板药使用率、抗栓药物的出血不良反应等情况进行分析，并分析年龄、合并慢性疾病、既往脑血管事件、出血风险评分等单因素对华法林使用率的影响。结果：房颤合并CKD患者的抗栓比例为68.9%，其中华法林抗凝比例为10.0%，低于肾功能正常患者；合并CKD患者的抗栓药物出血不良反应发生率为6.45%， CKD并未增加抗栓药物的出血不良反应发生率。华法林使用单因素分析提示高龄、冠心病、CKD对其影响较大。结论：我院房颤合并CKD患者的抗凝治疗严重不足。临床药师应加强药学服务，协助医师制定个体化用药方案，开展药学跟踪随访工作，确保抗凝治疗的延续性以及安全性。

Current Status of Anticoagulant Therapy in Patients with Atrial Fibrillation and Chronic Kidney Disease in Our Hospital

Objective: To retrospectively analyze the current application of anticoagulant therapy in pa-tients with atrial fibrillation (AF) and chronic kidney disease (CKD), provide reference for drug safety and rationality. Methods: Among the AF patients, 90 cases with CKD and 90 cases with normal renal function were selected randomly in the First People's Hospital of Nantong from January 2014 to December 2015. The usage of warfarin and antiplatelet drugs and related adverse reactions were analyzed. Simple factor like age, complicated chronic diseases, previous cerebrovascular events or bleeding risk on the use of warfarin was explored. Results: The rates of antithrombosis and anticoagulants in AF patients with CKD were 68.9% and 10.0%, lower than those in the normal renal function group. The rate of bleeding due to an-tithrombotic drugs was 6.45% in AF patients with CKD, which did not increase the risk. Univariate analy-sis showed that some risk factors such as age, coronary heart disease and CKD affected the usage of war-farin. Conclusion: In our hospital, the anticoagulant therapy in AF patients with CKD was seriously inade-quate. Clinical pharmacists should strengthen the pharmaceutical services to assist physicians to develop in-dividualized drug programs. And the work of follow-up should be done to ensure the continuity of antico-agulant therapy and safety.