北京市非瓣膜心房颤动病人日常抗血栓治疗现况分析

目的 了解北京市非瓣膜心房颤动（房颤）病人日常抗血拴治疗现状,发现房颤病人脑卒中预防存在的问题。方法从北京市城8区（东城区、西城区、海淀区、朝阳区、崇文区、宣武区、石景山区、丰台区）选择8所三级医院和7所二级医院（社区卫生服务中心）。由内科医生对门诊或病房非瓣膜房颤病人采取统一问卷调查。结果 583例病人中75％来源于门诊。其中64．3％来源于三级医院,35．7％来源于社区卫生服务中心。18．9％房颤病人服用华法林,其中39．1％国际标准化测量值（INR）控制在2．0～3．0。68．2％病人华法林服用时间在1年以内。5．7％病人曾经服用华法林。59．3％房颤病人服用阿司匹林,其中85．7％剂量在76～150mg／d,无一例剂量达到325mg／d。18．9％房颤病人未接受任何抗凝治疗。房颤病人不服用华法林的主要原因来自两方面：78．6％病人没有获得抗凝建议,75％以上病人缺乏抗凝知识。房颤病人卒中患病率22．8％,服用华法林者脑卒中患病率22．0％,服用阿司匹林者脑卒中患病率为24．3％,不采取任何措施者脑卒中患病率为21．3％,脑卒中患病率差异无统计学意义（χ^2=1．09,P=0．58）。结论 北京非瓣膜房颤病人抗凝治疗率低于抗血小板治疗率,华法林服用率在我国处于较高水平,但服用时间短,效果欠佳。脑卒中高危房颤病人阿司匹林服用率过高,剂量偏低。提高房颤病人抗凝治疗一方面要改变医生的行为,一方面提高病人抗凝治疗相关知识及治疗依从性。

Anticoagulation treatment in real-life practice of patient with nonvalvular atrial fibrillation in Beijing city

OBJECTIVE: To assess the anticoagulation treatment in real-life practice for nonvalvular atrial fibrillation (AF) in Beijing. METHODS: A questionnaire survey was conducted among 583 patients with nonvalvular AFF, 327 males and 256 females, aged 40 - 93, selected randomly from 8 general hospitals (n = 375, 64.3%) and 7 community health service centers (n = 208, 35.7%) located in the 8 districts in Beijing city, mainly from the out-patient departments (n = 437, 75%). RESULTS: 110 of the 583 patients (18.9%) were prescribed warfarin in which the percentage of international normalized ratio (INR) range (2.0 - 3.0) was 39.1% (n = 43). 68.2% of them had taken warfarin for less than one year. Another 33 patients (5.7%) had ever taken warfarin. 346 patients (59.3%) took aspirin of which 85.7% were exposed to the dose of 76 - 150 mg/d, and no one was administered the dose of 325 mg/d. 18.9% of the 583 patients had not received any anticoagulation or antiplatelet drugs. 78.6% of patients had never got the advice about taking warfarin from their doctors, and over 75% of the patients lacked in knowledge about the necessity of anticoagulation treatment for AF patients. The prevalence of stroke in the total 583 patients was 22.8%, 22.0% in those receiving warfarin treatment, 24.3% in those receiving aspirin treatment, and 21.3% in those receiving neither anticoagulation treatment nor antiplatelet treatment, without significant differences among them (chi(2) = 1.09, P = 0.58). CONCLUSION: The percentage of taking anticoagulation treatment in real-life practice pf the AF patients in Beijing is lower than that of taking antiplatelet treatment. The period of anticoagulation treatment is short and the effect is not good. The percentage of taking aspirin is too high in the high risk patients of stroke, but the dose of aspirin is on the low side. Doctors' advice and knowledge related to anticoagulation treatment of the patients are important factors influencing the anticoagulation treatment.