2021 年第 8 期 第 16 卷

心房颤动合并急性冠状动脉综合征患者抗凝治疗现状调查

Current status of anticoagulant therapy in patients with atrial fibrillation complicated with acute coronary syndrome

作者：白颖1王建旗2史旭波2王吉云2周震3张弨1

英文作者：Bai Ying1 Wang Jianqi2 Shi Xubo2 Wang Jiyun2 Zhou Zhen3 Zhang Chao1

单位：1首都医科大学附属北京同仁医院药学部100730；2首都医科大学附属北京同仁医院心血管中心100730；3首都医科大学生物医学工程学院，北京100069

英文单位：1Department of Pharmacy Beijing Tongren Hospital Capital Medical University Beijing 100730 China; 2Department of Cardiovascular Center Beijing Tongren Hospital Capital Medical University Beijing 100730 China; 3School of Biomedical Engineering Capital Medical University Beijing 100069 China

关键词：心房颤动；急性冠状动脉综合征；抗凝治疗

英文关键词：Atrialfibrillation;Acutecoronarysyndrome;Anticoagulanttherapy

• 摘要：

• 目的 探讨心房颤动合并急性冠状动脉综合征（ACS）患者抗凝治疗现状。方法 回顾性分析首都医科大学附属北京同仁医院2016年1月至2018年12月280例心房颤动合并ACS患者临床资料。根据是否使用口服抗凝药将患者分为未抗凝组（174例）和抗凝组（106例）。比较2组患者在年龄、性别、吸烟史、饮酒史、心房颤动及ACS类型、合并疾病、既往史、卒中风险评分、出血风险评分、合并用药等方面的差异。结果 抗凝组中持续性及永久性心房颤动、不稳定型心绞痛、行冠状动脉旁路移植术患者比例，合并高血压、脑卒中/短暂性脑缺血发作/血栓栓塞病史患者比例，CHA2DS2-VASc评分，以及合并使用比伐芦定、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂患者比例均高于未抗凝组，而抗凝组中阵发性心房颤动、ST段抬高型心肌梗死、行经皮冠状动脉介入术患者比例，合并高尿酸血症、贫血，肌酐清除率＜30 ml/min患者比例，本次入院时出血患者比例，CHA2DS2-VASc评分0～1分，合并使用肝素类药物、阿司匹林、氯吡格雷、替格瑞洛、替罗非班的患者比例均低于未抗凝组（均P＜0.05）。高卒中风险且高出血风险（CHA2DS2-VASc评分≥2分且HAS-BLED评分≥3分）患者138例（49.3%），抗凝比例为35.5%（49/138）。高卒中风险且低出血风险（CHA2DS2-VASc评分≥2分且HAS-BLED评分＜3分）患者131例（46.8%），抗凝比例为43.5%（57/131）。结论 首都医科大学附属北京同仁医院心房颤动合并ACS患者抗凝治疗现状与指南依然存在差距，阵发性心房颤动、ST段抬高型心肌梗死、行经皮冠状动脉介入术、合并高尿酸血症、贫血、肌酐清除率＜30 ml/min、入院时出血、CHA2DS2-VASc评分＜2分、合并使用肝素类药物、阿司匹林、氯吡格雷、替格瑞洛、替罗非班的患者较少抗凝治疗。我们需要综合分析患者抗凝治疗的获益与风险，不断提高心房颤动合并ACS患者的抗凝治疗率。

• Objective To analyze the current status of anticoagulant therapy in patients with atrial fibrillation (AF) complicated with acute coronary syndrome (ACS). Methods The clinical data of 280 patients with AF complicated with ACS in Beijing Tongren Hospital, Capital Medical University from January 2016 to December 2018 were retrospectively analyzed. Patients were divided into non-anticoagulant group (174 cases) and anticoagulant group (106 cases) according to whether oral anticoagulations was given or not. The age, gender, smoking and drinking history, AF and ACS classifications, comorbidities, past history, stroke risk score, bleeding risk score, and combined medication were compared between the two groups. Results In anticoagulant group, persistent and permanent AF, unstable angina, undergone coronary artery bypass grafting, hypertension, stroke/transient ischemic attack/thromboembolism history rates, CHA2DS2-VASc score, and combined use of bivalirudin and angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor antagonists rates were higher than those in non-anticoagulant group, while the proportion of patients with paroxysmal AF, ST segment elevation myocardial infarction, undergone percutaneous coronary intervention(PCI), hyperuricemia, anemia, creatinine clearance rate＜30 ml/min, bleeding on admission, CHA2DS2-VASc score as 0-1, and combined use of heparin, aspirin, clopidogrel, ticagrelor, tirofiban in anticoagulant group were lower than those in non-anticoagulant group(all P＜0.05). There were 138 cases（49.3%） with high risk of stroke and bleeding (CHA2DS2-VASc score≥2 and HAS-BLED score≥3) and the anticoagulant treatment rate was 35.5%（49/138）. There were 131 cases （46.8%） with high risk of stroke and low risk of bleeding (CHA2DS2-VASc score≥2 and HAS-BLED score＜3) and the anticoagulant treatment rate was 43.5%（57/131）. Conclusions There is a certain gap between the current status of our hospital and guidelines of anticoagulant therapy in patients with AF complicated with ACS. Patients with paroxysmal AF, ST segment elevation myocardial infarction, undergone PCI, hyperuricemia, anemia, creatinine clearance rate＜30 ml/min, bleeding on admission, CHA2DS2-VASc score＜2, and combined use of heparin, aspirin, clopidogrel, ticagrelor and tirofiban were less likely to choose anticoagulant therapy. We need to comprehensively analyze the benefits and risks of anticoagulant therapy in patients with AF complicated with ACS, and continuously improve the anticoagulant treatment rate of such special patients.