真实世界非瓣膜性房颤患者口服抗凝药物的使用研究

Study on Usage of Oral Anticoagulants in Real World with Nonvalvular Atrial Fibrillation Patients

关键词:  抗凝门诊  华法林  新型口服抗凝药物

Key words:  anticoagulation clinic  warfarin  new oral anticoagulants

摘要:

目的 探索抗凝门诊非瓣膜性房颤（non-valvular atrial fibrillation，NVAF）患者使用口服抗凝药物（oral anticoagulants，OAC）的情况，为真实世界研究指导临床实践提供数据支持。方法 对于2014—2019年抗凝门诊接受OAC治疗的NVAF患者的情况进行回顾性分析。结果 选择服用华法林者551人，达比加群酯者83人，利伐沙班者48人，符合口服OAC适应证（CHA2DS2-VASc评分男性≥1分、女性≥2分）者分别占89.7%，94.0%和93.8%；卒中低危患者中约50%为复律或射频消融前3周或后4周抗凝治疗；使用新型口服抗凝药物（new oral anticoagulants，NOACs）患者的平均年龄和既往有卒中史的比例高于华法林的患者。由于NOACs使用的方便性，临床实践中华法林转换为NOACs最为常见；仍有相当多的抗凝药物不依从的情况，其中1例患者因自行停用达比加群酯3 d导致短暂性脑缺血发作。结论 临床指南推荐NVAF患者优先选择NOACs，但真实世界使用华法林者占绝大多数，而NOACs较多用于高龄或既往卒中的患者，可能由于医师对于华法林的使用经验更为丰富和NOACs的价格较高等原因导致；药师对于不同抗凝药物之间转换的监护以及改善患者服药依从性是提高抗凝质量的重要举措。

Abstract:

OBJECTIVE To explore the use of oral anticoagulants in patients with non-valvular atrial fibrillation(NVAF) in a anticoagulation clinic, and to provide data support for real world research to guide clinical practice. METHODS Situation of NVAF patients treated with oral anticoagulants(OAC) in anticoagulation clinics from 2014 to 2019 were retrospectively analyzed. RESULTS The number of patients treated with warfarin, dabigatran and rivaroxaban were 551, 83 and 48 respectively. The percentage of NVAF patients with CHA2DS2-VASc scores(≥ 1 in males or ≥ 2 in females) who were treated the 3 anticoagulants were 89.7%, 94.0% and 93.8% respectively. About 50% of low stroke risk patients on anticoagulants were therapeutic anticoagulation for 3 weeks prior or 4 weeks after cardioversion or catheter ablation. The average age of patients and the proportion of patients with previous stroke history who received new oral anticoagulants(NOACs) were higher than that of warfarin. Due to ease of use of NOACs, the conversion of warfarin to NOACs was the most common in clinical practice. There were still considerable cases of non-compliance with anticoagulants, one of the patients suffered from transient ischemic attack after 3 days of self-deactivation of dabigatran. CONCLUSION The clinical guidelines recommend that patients with NVAF prefer NOACs, whereas warfarin is widely used in the real world and NOACs are mostly used in patients who were elderly or previous stroke. It can be due to doctors' more experienced use of warfarin and higher prices of NOACs. Focusing on the conversion between different anticoagulants and improving the compliance of taking anticoagulants by pharmacists are important measures to improve the quality of anticoagulation.