药物不良反应杂志
藥物不良反應雜誌
약물불량반응잡지
ADVERSE DRUG REACTIONS JOURNAL
2014年
1期
22-26
,共5页
刘佳%邵建屏%颜楠%朱华%罗璨
劉佳%邵建屏%顏楠%硃華%囉璨
류가%소건병%안남%주화%라찬
心房颤动%华法林%抗凝药%国际标准化比
心房顫動%華法林%抗凝藥%國際標準化比
심방전동%화법림%항응약%국제표준화비
Atrial fibrillation%Warfarin%Anticoagulants%International normalized ratio
目的 了解住院心房颤动(房颤)患者抗凝治疗中存在的问题,为更加安全的抗凝治疗提供依据. 方法 收集2013年1月1日至8月31日在江苏省苏北人民医院心内科住院治疗的所有非瓣膜性房颤患者病历资料进行回顾性分析.根据2010年《欧洲心脏病学会(ESC)心房颤动治疗指南》,采用CHADS2-VASc评分和HAS-BLED评分分别对患者进行血栓栓塞危险程度分层和出血风险评估.主要分析指标为接受不同房颤治疗方案(室率控制,节律控制)患者的血栓栓塞危险分层,出血风险评分,抗凝药物应用情况、国际标准化比值(INR)、出血合并症、血栓栓塞事件、患者用药依从性等. 结果 纳入分析的患者共134例,男性69例,女性67例;年龄20 ～ 91岁,平均(67±14)岁,CHA2DS2-VASc评分为0、1和≥2分者分别为11、23和100例,HAS-BELD评分≥3分者13例.接受室率控制和节律控制治疗者分别为85和49例.接受室率控制治疗的85例患者中CHA2DS2-VASc评分为0、1、≥2分者分别为1、12、72例.0分者1例使用阿司匹林.1分者12例中2例应用华法林,2例未行抗凝治疗(1例有禁忌证),8例使用抗血小板药物(阿司匹林、氯吡格雷单用或二药联用),其中2例单用氯吡格雷患者头颅CT检查均有多发性缺血灶.≥2分者72例中33例应用华法林,35例应用抗血小板药物,4例未行抗凝治疗.接受华法林抗凝治疗的患者出院时25例INR＜2.0,7例INR为2.0～3.0,1例INR＞ 3.0.接受节律控制治疗的49例患者CHA2DS2-VASc评分平均为(2.3±1.8),HAS-BLED评分平均为(1.3±1.1),其中25例应用华法林,出院时17例INR ＜2.0,5例INR为2.0 ～3.0,2例INR＞ 3.0.1例患者未监测INR.134例患者中有15例(11.2％)出现脑梗死,其中8例(53.3％)应用华法林抗凝治疗,患者出院时INR均未达标. 结论 住院房颤患者抗凝治疗中存在的主要问题是采用华法林抗凝的比例较低,采用华法林治疗的部分患者抗凝强度不足.临床医师过分担心发生出血合并症是抗凝治疗不规范的主要原因.
目的 瞭解住院心房顫動(房顫)患者抗凝治療中存在的問題,為更加安全的抗凝治療提供依據. 方法 收集2013年1月1日至8月31日在江囌省囌北人民醫院心內科住院治療的所有非瓣膜性房顫患者病歷資料進行迴顧性分析.根據2010年《歐洲心髒病學會(ESC)心房顫動治療指南》,採用CHADS2-VASc評分和HAS-BLED評分分彆對患者進行血栓栓塞危險程度分層和齣血風險評估.主要分析指標為接受不同房顫治療方案(室率控製,節律控製)患者的血栓栓塞危險分層,齣血風險評分,抗凝藥物應用情況、國際標準化比值(INR)、齣血閤併癥、血栓栓塞事件、患者用藥依從性等. 結果 納入分析的患者共134例,男性69例,女性67例;年齡20 ～ 91歲,平均(67±14)歲,CHA2DS2-VASc評分為0、1和≥2分者分彆為11、23和100例,HAS-BELD評分≥3分者13例.接受室率控製和節律控製治療者分彆為85和49例.接受室率控製治療的85例患者中CHA2DS2-VASc評分為0、1、≥2分者分彆為1、12、72例.0分者1例使用阿司匹林.1分者12例中2例應用華法林,2例未行抗凝治療(1例有禁忌證),8例使用抗血小闆藥物(阿司匹林、氯吡格雷單用或二藥聯用),其中2例單用氯吡格雷患者頭顱CT檢查均有多髮性缺血竈.≥2分者72例中33例應用華法林,35例應用抗血小闆藥物,4例未行抗凝治療.接受華法林抗凝治療的患者齣院時25例INR＜2.0,7例INR為2.0～3.0,1例INR＞ 3.0.接受節律控製治療的49例患者CHA2DS2-VASc評分平均為(2.3±1.8),HAS-BLED評分平均為(1.3±1.1),其中25例應用華法林,齣院時17例INR ＜2.0,5例INR為2.0 ～3.0,2例INR＞ 3.0.1例患者未鑑測INR.134例患者中有15例(11.2％)齣現腦梗死,其中8例(53.3％)應用華法林抗凝治療,患者齣院時INR均未達標. 結論 住院房顫患者抗凝治療中存在的主要問題是採用華法林抗凝的比例較低,採用華法林治療的部分患者抗凝彊度不足.臨床醫師過分擔心髮生齣血閤併癥是抗凝治療不規範的主要原因.
목적 료해주원심방전동(방전)환자항응치료중존재적문제,위경가안전적항응치료제공의거. 방법 수집2013년1월1일지8월31일재강소성소북인민의원심내과주원치료적소유비판막성방전환자병력자료진행회고성분석.근거2010년《구주심장병학회(ESC)심방전동치료지남》,채용CHADS2-VASc평분화HAS-BLED평분분별대환자진행혈전전새위험정도분층화출혈풍험평고.주요분석지표위접수불동방전치료방안(실솔공제,절률공제)환자적혈전전새위험분층,출혈풍험평분,항응약물응용정황、국제표준화비치(INR)、출혈합병증、혈전전새사건、환자용약의종성등. 결과 납입분석적환자공134례,남성69례,녀성67례;년령20 ～ 91세,평균(67±14)세,CHA2DS2-VASc평분위0、1화≥2분자분별위11、23화100례,HAS-BELD평분≥3분자13례.접수실솔공제화절률공제치료자분별위85화49례.접수실솔공제치료적85례환자중CHA2DS2-VASc평분위0、1、≥2분자분별위1、12、72례.0분자1례사용아사필림.1분자12례중2례응용화법림,2례미행항응치료(1례유금기증),8례사용항혈소판약물(아사필림、록필격뢰단용혹이약련용),기중2례단용록필격뢰환자두로CT검사균유다발성결혈조.≥2분자72례중33례응용화법림,35례응용항혈소판약물,4례미행항응치료.접수화법림항응치료적환자출원시25례INR＜2.0,7례INR위2.0～3.0,1례INR＞ 3.0.접수절률공제치료적49례환자CHA2DS2-VASc평분평균위(2.3±1.8),HAS-BLED평분평균위(1.3±1.1),기중25례응용화법림,출원시17례INR ＜2.0,5례INR위2.0 ～3.0,2례INR＞ 3.0.1례환자미감측INR.134례환자중유15례(11.2％)출현뇌경사,기중8례(53.3％)응용화법림항응치료,환자출원시INR균미체표. 결론 주원방전환자항응치료중존재적주요문제시채용화법림항응적비례교저,채용화법림치료적부분환자항응강도불족.림상의사과분담심발생출혈합병증시항응치료불규범적주요원인.
Objective To explore the problem of anticoagulation therapy in hospitalized patients with atrial fibrillation and obtain evidences for safer anticoagulant therapy in clinical practice.Methods The medical records of patients with non-valvular atrial fibrillation who were hospitalized in Department of Cardiology,Northern Jiangsu People's Hospital from January 1 to August 31,2013 were collected and analyzed retrospectively.The patients were evaluated after risk stratification of thromboembolism and the risk of hemorrhage by CHADS2-VASc score and HAS-BLED score according to the 2010 ESC Guidelines for Management of Atrial Fibrillation.The main indicators of analysis included the patients' risk stratification of thromboembolism,the score of risk of hemorrhage,the situation of applying anticoagulant,international normalized ratio (INR),hemorrhagic complication,thromboembolic events,and the compliance with medication in patients who received different therapeutic regimen of atrial fibrillation (ventricular rate control and rhythm control).Results A total of 134 patients were enrolled into the study,including 69 male and 67 female with an average age of(67 ± 14)years (20 to 91years).The number of patients whose CHA2DS2-VASc score 0,1,and ≥2 were 11,23,and 100,respectively.The number of patients whose HAS-BELD score ≥3 was 13.The patients who received the ventricular rate control and the rhythm control therapy were 85 and 49,respectively.Among the 85 patients who received the rate control treatment,there were 1,12,72cases whose CHA2DS2-VASc scores were 0,1,and ≥2,respectively.One patient with CHA2DS2-VASc score 0 received aspirin.Two,8,and 2 patients with CHA2DS2-VASc score 1 received warfarin,antiplatelet drug (only aspirin,only clopidogrel or both),and did not receive any anticoagulants (one patient had contraindication),respectively.There were 2 patients who received only clopidogrel developed multiple focal cerebral ischemia as shown by head CT examination in the 8 patients who received antiplatelet drugs.Thirty-three,35,and 4 patients with CHA2DS2-VASc score≥2 received warfarin,antiplatelet drug and did not receive any anticoagulants,respectively.The cases number of INR ＜ 2.0,2.0-3.0,and ＞ 3.0 were 25,7 and 1 respectively in patients who received warfarin on discharge.The average CHA2DS2-VASc score and HAS-BLED score in 49 patients who received the rhythm control therapy were (2.3 ± 1.8) and (1.3 ± 1.1),respectively.Twenty-five patients received warfarin.The number of INR ＜ 2.0,2.0-3.0,and ＞ 3.0 were 17,5 and 2 respectively in patients who received warfarin on discharge.One patient did not monitor INR.Fifteen of 134 patients developed cerebral infarction.Among them,8 patients (53.3％)received warfarin and none achieved INR standard on discharge.Conclusions The main problems of anticoagulation therapy in hospitalized patients with atrial fibrillation are the lower rate of receiving warfarin therapy and the lower intensity of anticoagulation treatment.Unnecessary concern of clinicians about hemorrhagic complication is the main reason of irregular anticoagulant therapy.
