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目的分析影响老年非瓣膜性心房颤动患者抗凝治疗的因素,为提高老年心房颤动患者抗凝治疗寻求解决方法。方法对2009-10-01—2010-04-30入住北京协和医院,年龄≥65岁的老年非瓣膜性心房颤动患者进行门诊及电话随访,观察分析全因死亡、抗凝比例、未选择抗凝的原因、抗凝终止的原因、不抗凝(抗凝终止)后的抗栓方法等指标。结果共70例连续入院的患者纳入研究,平均随访9.1个月(6.0~13.5个月)。有效随访63例,其中包括年龄<75岁组33例和年龄≥75岁组30例。失访7例(10%)。随访期间共8例(12.7%)死亡,包括年龄<75岁组1例(3%)和年龄≥75岁组7例(23.3%)。有效随访病例中,进行抗凝治疗的仅16例(25.4%),这16例中INR达标13例。8例死亡患者均未进行抗凝治疗,其中6例称大夫未交待抗凝,另2例有明确抗凝禁忌证。结论老年心房颤动患者抗凝比例低,有效抗凝率低。抗凝过程中中断的比例高。解决老年心房颤动患者抗凝过程的具体困难是有效治疗的关键。
Objective To analyze the factors influencing the anticoagulation therapy in elderly patients with non-valvular atrial fibrillation and to find a solution to improve anticoagulant therapy in elderly patients with atrial fibrillation. Methods The patients with senile non-valvular atrial fibrillation who were admitted to Beijing Union Medical College Hospital from October 2009 to January 2010 were enrolled in the clinic and followed up by telephone. All-cause death, anticoagulation rate, non-selective anticoagulation Of the reasons for the reasons for the termination of anticoagulation, anti-coagulation (anticoagulant termination) after the antithrombotic method and other indicators. Results A total of 70 consecutive hospitalized patients were enrolled in the study, with a mean follow-up of 9.1 months (6.0 to 13.5 months). Effective follow-up of 63 cases, including 33 cases of age <75 years old and age> 75 years old group of 30 cases. Lost in 7 cases (10%). A total of 8 patients (12.7%) died during follow-up, including 1 (3%) in age <75 years and 7 patients (23.3%) in age ≥75 years. Among the effective follow-up cases, only 16 patients (25.4%) were treated with anticoagulant therapy and 13 of these 16 patients achieved an INR standard. None of the 8 deaths were treated with anticoagulant therapy, 6 of whom reported that the doctor did not confessed to anticoagulation and the other 2 had definite anticoagulation contraindications. Conclusion Elderly patients with atrial fibrillation anticoagulation rate is low, effective anticoagulant rate is low. Anticoagulation process interrupt the high proportion. The key to effective treatment is to address the specific difficulties of anticoagulation in elderly patients with atrial fibrillation.