目的 调查房颤患者的流行病学资料和抗凝治疗现状,为提高房颤患者的抗凝效率提供资料。方法 调查华山医院门诊及病房1 000例房颤患者的病史、一般情况、合并疾病、辅助检查和治疗方案,按照脑卒中史学、脑卒中风险评分及CHA2DS2-VASc评分情况进行分层分析,了解房颤患者临床特征和抗凝现状。结果 1 000例房颤患者平均年龄(72.1±11.1)岁,合并疾病前3位为高血压病(65%)、冠心病(32%)和糖尿病(27%)。非瓣膜性房颤(non-valvular atrial fibrillation,NVAF)患者占6%。22%的房颤患者有脑卒中史,根据脑卒中与否分组,脑卒中组年龄更大、房颤病程更长、高血压控制更差。所有患者总体抗凝比32%,抗血小板比46%。脑卒中组抗凝比例44%,高于非脑卒中组 (P<0.001)。但78%房颤患者在经历脑卒中后才开始抗凝。NVAF患者CHA2DS2-VASc评分为2~5分时,抗凝比例随分值增加而增加。2~6分时患者抗血小板比例增高,7~8分时,抗凝和抗血小板比例都减少。结论 目前房颤患者抗凝比例低,抗凝主要集中于房颤合并脑卒中患者。抗凝治疗减少脑卒中的发生,脑卒中后的抗凝仍可获益。但脑卒中前抗凝意义更大。
Objective To investigate the epidemiological status and the anticoagulation treatment of atrial fibrillation (AF) patients,and to provide evidence for improving anticoagulation therapeutic effect in AF patients.Methods We performed a cross-sectional epidemiological investigation of 1 000 patients and out-patients with AF in Huashan Hospital.The clinical data including clinical feature,coexistent diseases,auxiliary examination,and treatment regimen of these patients were collected.The clinical features and anticoagulation status of AF patients were analyzed based on the stroke history,stroke risk evaluation and CHA2DS2-VASc score stratification.Results The mean age of these AF patients was (72.1±11.1) years old.The most common coexistent diseases were hypertension (65%),coronary heart disease (32%) and diabetes (27%).About 6% of the AF patients were diagosed with non-valvularatrial fibrillation (NVAF),and 22% had stroke history.Patients were divided into two groups according to their stroke history.Compared with the non-stroke group,the stroke group was found to be older,with longer course of AF and poorer hypertension control.The overall anticoagulation rate was 32% and antiplatelet rate was 46%.The anticoagulation rate of stroke group was 44%,higher than the non-stroke group (P＜0.001) but 78% of these patients began anticoagulation therapy after the occurrence of stroke.When CHA2DS2-VASc scores of NVAF patients were 2 to 5,the anticoagulation proportion increased gradually.When the scores were 2 to 6,the antiplatelet ratio increased gradually.But when the scores were 7-8 points,both anticoagulation and antiplatelet rates were in decline.Conclusions The anticoagulation rate in AF patients was still low at present,while relatively higher in patients with stroke.Anticoagulation could prevent stroke,AF patients still could benefit from anticoagulation after stroke,but anticoagulation before stroke could get more benefits.
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