|本期目录/Table of Contents|

[1]李丹丹,庄微,宫剑滨.单中心非瓣膜性心房颤动患者抗凝治疗的现状分析[J].医学研究与战创伤救治(原医学研究生学报),2021,23(04):363-367.[doi:10.3969/j.issn.1672-271X.2021.04.006]
　LI Dan-dan,ZHUANG Wei,GONG Jian-bin.Analyze the status of anticoagulant therapy in patients with nonvalvular atrial fibrillation[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2021,23(04):363-367.[doi:10.3969/j.issn.1672-271X.2021.04.006]
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单中心非瓣膜性心房颤动患者抗凝治疗的现状分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第23卷
期数:
2021年04期
页码:
363-367
栏目:
临床研究
出版日期:
2021-08-10

文章信息/Info

Title:
Analyze the status of anticoagulant therapy in patients with nonvalvular atrial fibrillation
作者:
李丹丹; 庄微; 宫剑滨
作者单位：210002南京，南京医科大学金陵临床医学院（东部战区总医院）心血管内科（李丹丹、庄微、宫剑滨）
Author(s):
LI Dan-dan;  ZHUANG Wei;  GONG Jian-bin
(Department of Cardiovascular Medicine, Jinling Hospital, Nanjing Medical University / General Hospital of Eastern Theater Command, PLA, Nanjing 210002, Jiangsu, China)
关键词:
心房颤动; 抗凝; 新型口服抗凝药; 华法林
Keywords:
atrial fibrillation;  anticoagulant;  new oral anticoagulant;  warfarin
分类号:
R541.75
DOI:
10.3969/j.issn.1672-271X.2021.04.006
文献标志码:
A
摘要:
目的分析非瓣膜性心房颤动（NVAF）患者的抗凝治疗现状，分析口服抗凝药（OAC）治疗后血栓栓塞、出血发生情况。方法回顾性分析2016年1月至2020年1月东部战区总医院心血管内科收治的确诊为NVAF的457例患者临床资料。根据患者治疗方案分为抗凝组349例（76.4%）和未抗凝组108例（23.6%）。抗凝组又分为华法林亚组72例（15.8%）、达比加群酯亚组166例（36.3%）、利伐沙班亚组111例（24.3%）；其中达比加群酯亚组与利伐沙班亚组合称为新型口服抗凝药（NOAC）组。采用CHA2DS2-VASc评分、HAS-BLED评分评估血栓栓塞、出血风险，通过本中心患者病历系统或电话随访患者出院后服用OAC发生血栓栓塞、出血事件情况，回顾性分析上述临床资料。结果血栓栓塞风险中高危患者394例（86.2%），其中抗凝治疗303例（76.9%）；高出血风险患者103例（22.5%），其中未抗凝患者28例（27.2%）。在血栓栓塞事件发生方面，抗凝组明显低于未抗凝组 [20（5.7%） vs 34（31.5%）,P<0.01]；NOAC组与华法林亚组比较差异无统计学意义[16（5.8%）vs 4（5.6%）,P>0.05]；达比加群酯亚组优于利伐沙班亚组[5（3.0%） vs 11（9.9%），P<0.05]。在出血事件发生方面，抗凝组较未抗凝组高[19（5.4%） vs 0（0%），P<0.05]；其中抗凝组有2例（0.6%）出现致命性脑出血，余为非致命性出血事件；NOAC组较华法林亚组低[9（3.2%）vs 10（13.9%），P<0.05]，2组中各有1例患者发生致命性脑出血（0.3% vs 1.0%，P>0.05）；达比加群酯亚组与利伐沙班亚组相当[4（2.4%）vs 5（4.5%）,P>0.05]。结论NVAF患者抗凝治疗是必要的，其中OAC以选择NOAC较多。NOAC抗凝治疗与华法林抗凝治疗预防血栓栓塞效果相当，但较华法林安全。达比加群酯在预防血栓栓塞事件方面优于利伐沙班，不排除与研究中利伐沙班普遍剂量偏小有关，两者安全性相当。临床医师应强化抗凝意识，结合患者实际情况选择合适的口服抗凝药。
Abstract:
ObjectiveTo observe the status of anticoagulation treatment in patients with non-valvular atrial fibrillation (NVAF), and to analyze embolism and bleeding after oral anticoagulants (OAC) treatment.MethodsA total of 457 patients diagnosed with NVAF during the hospitalization period in Eastern Theater General Hospital from January 2016 to June 2020 were enrolled. According to the patient’s treatment, the enrolled patients were divided into anticoagulation group [349 cases（76.4%）] and non-anticoagulation group [108 cases（23.6%）]. Anticoagulation group included warfarin group [72 cases（15.8%）], dabigatran group [166 cases（36.3%）], rivaroxaban group [111 cases（24.3%）]. Dabigatran group and rivaroxaban group were called NOAC group. The CHA2DS2-VASC score and HAS-BLED score were used to assess the risk of embolism and bleeding. The occurrence of embolism or bleeding in patients who were taken OAC were investigated by follow-up via telephone and/or the patient’s medical system, and the ret-rospective analysis was performed.ResultsA total of 394 patients (86.2%) were at medium and high risk of embolism, of which 303 cases (76.9%) were treated with OAC. 103 cases (22.5%) were at high risk of bleeding, of which 28 cases were not treated with OAC (27.2%). In terms of embolic events, the anticoagulation group was significantly lower than the non-anticoagulation group (5.7% vs 31.5%), P<0.01. There was no significant difference between the NOAC group and the warfarin group (5.6% vs 4.6%), P>0.05. The dabigatran group was lower than the rivaroxaban group (3.0% vs 9.9%), P<0.05. In the bleeding events, the anticoagulation group was higher than the non-anticoagulation group (5.4% vs 0%), P<0.01, of which 2 cases (0.6%) in the anticoagulation group had fatal cerebral hemorrhage. The NOAC group was lower than the warfarin group (3.2% vs 13.9%), P<0.05, and 1 patient in each of the two groups had fatal cerebral hemorrhage (0.3% vs 1.0%), P>0.05. The dabigatran group was equivalent to the rivaroxaban group (2.4% vs 4.5%), P>0.05.ConclusionThis study show that anticoagulation therapy is necessary, and most NVAF patients choice NOAC to anticoagulant. NOAC anticoagulation therapy is equivalent to warfarin, but it is safer than warfarin. Dabigatran is better than rivaroxaban in preventing embolic events, and the safety of the two is equivalent. Obviously, clinicians should strengthen the awareness of anticoagulation and choose appropriate OAC based on the actual situation of the patient.

参考文献/References:

[1]Wang Z, Chen Z, Wang X, et al. The Disease Burden of Atrial Fibrillation in China from a National Cross-sectional Survey[J]. Am J Cardiol，2018，122(5):793-798.
[2]Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials[J]. Lancet，2014，383(9921):955-962.
[3]Steffel J, Verhamme P, Potpara TS, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation[J]. Eur Heart J，2018，39(16):1330-1393.
[4]Ma C, Riou Franca L, Lu S, et al. Stroke prevention in atrial fibrillation changes after dabigatran availability in China: The GLORIA-AF registry[J]. J Arrhythm，2020，36(3):408-416.
[5]黄从新，张澍，黄德嘉. 心房颤动：目前的认识和治疗的建议-2018[J]. 中国心脏起搏与心电生理杂志，2018，32(4):315-368.
[6]Sepehri Shamloo A, Dagres N, Hindricks G. 2020 ESC guidelines on atrial fibrillation: Summary of the most relevant recommendations and innovations[J]. Herz，2021，46(1):28-37.
[7]January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons[J]. Circulation，2019，140(2):e125-e151.
[8]王燕. 高风险高龄心房颤动患者抗凝与联合抗栓疗效及安全性比较[J]. 东南国防医药，2017，19(5):522-523.
[9]中华医学会心血管病分会, 中国老年学学会心脑血管病专业委员会. 华法林抗凝治疗的中国专家共识[J]. 中华内科杂志，2013，52(1):76-82.
[10]Ugowe FE, Jackson LR 2nd, Thomas KL. Racial and ethnic differences in the prevalence, management, and outcomes in patients with atrial fibrillation: A systematic review[J]. Heart Rhythm，2018，15(9):1337-1345.
[11]Wilke T, Bauer S, Mueller S, et al. Patient Preferences for Oral Anticoagulation Therapy in Atrial Fibrillation: A Systematic Literature Review[J]. Patient，2017，10(1):17-37.
[12]Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation[J]. N Engl J Med，2009，361(12):1139-1151.
[13]Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation[J]. N Engl J Med，2011，365(10):883-891.
[14]Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation[J]. N Engl J Med，2011，365(11):981-992.
[15]Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation[J]. N Engl J Med，2013，369(22):2093-2104.
[16]Katerenchuk V, Duarte GS, Martins EPG, et al. Satisfaction of Patients with Nonvitamin K Anticoagulants Compared to Vitamin K Antagonists: a Systematic Review and Meta-analysis[J]. Thromb Haemost，2021，121(3):366-382.
[17]Lee SR, Rhee TM, Kang DY, et al. Meta-Analysis of Oral Anticoagulant Monotherapy as an Antithrombotic Strategy in Patients With Stable Coronary Artery Disease and Nonvalvular Atrial Fibrillation[J]. Am J Cardiol，2019，124(6):879-885.
[18]张悦悦, 蒋晨阳. 心房颤动卒中预防的非药物疗法进展[J]. 心血管病学进展，2018，39(1):6-10.
[19]黄从新, 张澍, 黄德嘉,等. 左心耳干预预防心房颤动患者血栓栓塞事件:目前的认识和建议-2019[J]. 中国心脏起搏与心电生理杂志，2019，33(5):385-401.
[20]Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS[J]. Eur Heart J，2016，37(38):2893-2962.
[21]那丞, 黄织春. 心脏自主神经及其重构区参与心房颤动的机制的研究进展[J]. 医学研究生学报，2020，33(8):879-883.
[22]Glikson M, Wolff R, Hindricks G, et al. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion-an update[J]. Europace，2019. doi: 10.1093/europace/euz258.
[23]吴立群, 黄从新, 黄德嘉,等. 经冷冻球囊导管消融心房颤动中国专家共识[J]. 中国心脏起搏与心电生理杂志，2020，34(2):95-105.
[24]王健, 曹小虎, 廖清池,等. 左心耳封堵术相关的一站式手术临床应用进展[J]. 中华老年心脑血管病杂志，2021，23(1):102-104.

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备注/Memo:
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更新日期/Last Update: 2021-08-10