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目的探讨门诊心房颤动(atrial fibrillation,AF)患者抗凝治疗的依从性以及新型抗凝药物对潜在依从性的影响。方法从2014年8月—2015年6月,对南京中医药大学附属江苏省中医院门诊非瓣膜性AF患者关于抗凝依从性及抗凝相关知识、意愿等方面进行问卷调查。调查内容包括患者的一般人群资料、应用华法林抗凝现状、患者对抗凝知识的认知程度和意愿,以及对患者改用新型抗凝药物达比加群酯的认知程度、经济接受程度和应用意愿。结果共收到105例患者的有效问卷。105例非瓣膜AF中,89例符合抗凝指征,而服用华法林的治疗率为44.9%,达标率仅为37.1%。16.9%曾服用华法林,由于某种原因停药,38.2%的患者从未应用任何药物进行抗凝治疗。在抗凝知识、意愿的调查中,超半数的患者对抗凝重要性及抗凝的关键环节认知欠缺(67.6%)。大部分患者表示华法林服用及监测方式是阻碍坚持抗凝的重要因素。而在新型抗凝药物相关的调查中,将考虑新型抗凝药物者70例,但认为新型抗凝药物目前的价格较贵,并因此难以接受患者达65例,如新型抗凝药物价格下调至可接受范围,将接受新型抗凝药物治疗者85例。结论门诊非瓣膜性AF患者应用华法林进行抗凝的治疗率和达标率均不如人意,其中部分是由于华法林药物服用及监测方式影响了医患双方的积极性,新型抗凝药物有望改善抗凝现状,而新型抗凝药物有可能成为克服这种状况的重要选择。
Objective To investigate the compliance of anticoagulant therapy in outpatients with atrial fibrillation (AF) and the impact of new anticoagulants on the potential compliance. Methods From August 2014 to June 2015, a questionnaire survey was conducted among patients with non-valvular AF in Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine from August 2014 to June 2015 on the knowledge of anticoagulation compliance and anticoagulation. The survey included general population data, the use of warfarin anticoagulation, the patient’s knowledge of anticoagulation awareness and willingness, and the use of the new anticoagulant drug, dabigatran, the degree of economic acceptance and Willingness to apply. Results A total of 105 valid questionnaires were received. Of the 105 non-valvular AFs, 89 were eligible for anticoagulation, compared with 44.9% for warfarin and 37.1% of patients achieving compliance. 16.9% had taken warfarin and discontinued for some reason, and 38.2% never used any medication for anticoagulation. In the knowledge of anticoagulation, the willingness of the survey, more than half of the patients on the importance of anticoagulation and anticoagulation key link cognitive deficiencies (67.6%). Most patients said that taking warfarin and monitoring the way is an obstacle to adhere to an important factor in anticoagulation. In the new anticoagulant-related survey, 70 new anticoagulants will be considered, but the new anticoagulants are considered more expensive and therefore difficult to accept in up to 65 patients. If the price of new anticoagulants is lowered to Acceptable range, will receive 85 cases of new anticoagulant therapy. Conclusions The rates of treatment and compliance with warfarin for out-patient non-valvular AF in patients with AF are unsatisfactory, partly because the warfarin administration and monitoring methods affect the enthusiasm of both doctors and patients, and new anticoagulants are expected to improve Anticoagulant status, and new anticoagulants may be an important choice to overcome this situation.