Anticoagulation Therapy for Chinese Elderly Patients with Atrial Fibrillation　#br#

doi:10.12114/j.issn.1007-9572.2018.00.079

Abstract

Abstract: Atrial fibrillation （AF） is a common arrhythmia in the elderly，which is an important independent risk factor of ischemic stroke（IS）.Both the prevalence of AF and the incidence of IS related with AF are increasing with age.Moreover，thrombosis-related IS is a major cause of mortality and disability of AF patients.Thankfully，it is accepted that anticoagulantion therapy can reduce the incidence of IS and systemic thromboembolism related with AF，but an unsatisfactory status was reported in China，especially in the elderly patients.We analyzed the status and associated factors of anticoagulation therapy in elderly patients with non-valvular AF in China，with a view to improving physicians and patients' understanding of the importance of anticoagulation therapy.

Key words: Atrial fibrillation, Aged, Anticoagulants, Review

摘要： 心房颤动（房颤）是老年人常见的一种心律失常，是缺血性卒中重要的独立危险因素之一，随着年龄的增长，房颤的患病率及卒中的发病率均逐渐增加。血栓栓塞所致的缺血性卒中是房颤患者致残、致死的主要原因。规范的抗凝治疗可显著降低卒中及全身血栓栓塞事件的发生。但目前我国抗凝治疗现状不尽如人意，尤其是老年房颤患者。本文对老年非瓣膜病房颤患者的抗凝治疗现状及影响规范化抗凝治疗的因素进行综述，旨在提高各界对抗凝治疗的认识和重视。

关键词: 心房颤动, 老年人, 抗凝药, 综述

YAN Jing-jing,QIN Ming-zhao. Anticoagulation Therapy for Chinese Elderly Patients with Atrial Fibrillation　#br#[J]. Chinese General Practice, 2018, 21(27): 3285-3289. DOI: 10.12114/j.issn.1007-9572.2018.00.079.
闫静静,秦明照. 中国老年心房颤动患者抗凝治疗现状及分析[J]. 中国全科医学, 2018, 21(27): 3285-3289. DOI: 10.12114/j.issn.1007-9572.2018.00.079.

References

［1］CHUGH S S，HAVMOELLER R，NARAYANAN K，et al.Worldwide epidemiology of atrial fibrillation：a Global Burden of Disease 2010 Study［J］.Circulation，2014，129（8）：837-847.DOI：10.1161/CIRCULATIONAHA.113.005119.3288
［2］ZONI-BERISSO M，LERCARI F，CARAZZA T，et al.Epidemiology of atrial fibrillation：European perspective［J］.Clin Epidemiol，2014，6：213-220.DOI：10.2147/CLEP.S47385.3288
［3］COLILLA S，CROW A，PETKUN W，et al.Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S.adult population［J］.Am J Cardiol，2013，112（8）：1142-1147.DOI：10.1016/j.amjcard.2013.05.063.3288
［4］CHIANG C E，WANG K L，LIP G Y.Stroke prevention in atrial fibrillation：an Asian perspective［J］.Thromb Haemost，2014，111（5）：789-797.DOI：10.1160/TH13-11-0948.3288
［5］TSE H F，WANG Y J，AHMED AI-ABDULLAH M，et al.Stroke prevention in atrial fibrillation——an Asian stroke perspective［J］.Heart Rhythm，2013，10（7）：1082-1088.DOI：10.1016/j.hrthm.2013.03.017.3288
［6］GUO Y，TIAN Y，WANG H，et al.Prevalence，incidence，and lifetime risk of atrial fibrillation in China：new insights into the global burden of atrial fibrillation［J］.Chest，2015，147（1）：109-119.DOI：10.1378/chest.14-0321.3288
［7］LI L H，SHENG C S，HU B C，et al.The prevalence，incidence，management and risks of atrial fibrillation in an elderly Chinese population：a prospective study［J］.BMC Cardiovasc Disord，2015，15：31.DOI：10.1186/s12872-015-0023-3.3288
［8］ZHOU Z，HU D.An epidemiological study on the prevalence of atrial fibrillation in the Chinese population of mainland China［J］.J Epidemiol，2008，18（5）：209-216.DOI：10.2188/jea.JE2008021.3288
［9］HART R G，DIENER H C，COUTTS S B，et al.Embolic strokes of undetermined source：the case for a new clinical construct［J］.Lancet Neurol，2014，13（4）：429-438.DOI：10.1016/S1474-4422（13）70310-7.3288
［10］YIIN G S，HOWARD D P，PAUL N L，et al.Recent time trends in incidence，outcome and premorbid treatment of atrial fibrillation-related stroke and other embolic vascular events：a population-based study［J］.J Neurol Neurosurg Psychiatry，2017，88（1）：12-18.DOI：10.1136/jnnp-2015-311947.3288
［11］KIRCHHOF P，BENUSSI S，KOTECHA D，et al.2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS［J］.Eur J Cardiothorac Surg，2016，50（5）：e1-88.DOI：10.1093/ejcts/ezw313.3288
［12］马长生.老年心房颤动患者的华法林抗凝治疗［J］.中华老年心脑血管病杂志，2006，8（10）：649-651.DOI：10.3969/j.issn.1009-0126.2006.10.001.3288
［13］郭豫涛.中国老年心房颤动临床流行病学和抗栓管理现状及变化［J］.中华老年心脑血管病杂志，2017，19（9）：988-990.DOI：10.3969/j.issn.1009-0126.2017.09.024.3288
GUO Y T.Clinical epidemiology and antithrombotic management status and changes of atrial fibrillation in the elderly in China［J］.Chinese Journal of Geriatric Heart Brain and Vessel Diseases，2017，19（9）：988-990.DOI：10.3969/j.issn.1009-0126.2017.09.024.3288
［14］GUO Y，WANG H，TIAN Y，et al.Time trends of aspirin and warfarin use on stroke and bleeding events in Chinese patients with new-onset atrial fibrillation［J］.Chest，2015，148（1）：62-72.DOI：10.1378/chest.14-2018.3288
［15］GUO Y，PISTERS R，APOSTOLAKIS S，et al.Stroke risk and suboptimal thromboprophylaxis in Chinese patients with atrial fibrillation：would the novel oral anticoagulants have an impact?［J］.Int J Cardiol，2013，168（1）：515-522.DOI：10.1016/j.ijcard.2012.09.187.3288
［16］VAN ASCH C J，LUITSE M J，RINKEL G J，et al.Incidence，case fatality，and functional outcome of intracerebral haemorrhage over time，according to age，sex，and ethnic origin：a systematic review and meta-analysis［J］.Lancet Neurol，2010，9（2）：167-176.DOI：10.1016/S1474-4422（09）70340-0.3288
［17］JOHNSON J A，CAUDLE K E，GONG L，et al.Clinical Pharmacogenetics Implementation Consortium （CPIC） Guideline for Pharmacogenetics-Guided Warfarin Dosing：2017 Update［J］.Clin Pharmacol Ther，2017，102（3）：397-404.DOI：10.1002/cpt.668.3288
［18］ZENG W T，XU Q，LI C H，et al.Influence of genetic polymorphisms in cytochrome P450 oxidoreductase on the variability in stable warfarin maintenance dose in Han Chinese［J］.Eur J Clin Pharmacol，2016，72（11）：1327-1334.DOI：10.1007/s00228-016-2098-x.3288
［19］MACLE L，CAIRNS J，LEBLANC K，et al.2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation［J］.Can J Cardiol，2016，32（10）：1170-1185.DOI：10.1016/j.cjca.2016.07.591.3288
［20］JANUARY C T，WANN L S，ALPERT J S，et al.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 practice guidelines and the Heart Rhythm Society［J］.Circulation，2014，130（23）：e199-267.DOI：10.1161/CIR.0000000000000041.3289
［21］LIP G Y.Bleeding risk assessment and management in atrial fibrillation patients［J］.Eur Heart J，2012，33（2）：147-149.DOI：10.1093/eurheartj/ehr431.3289
［22］INOUE H，OKUMURA K，ATARASHI H，et al.Target international normalized ratio values for preventing thromboembolic and hemorrhagic events in Japanese patients with non-valvular atrial fibrillation：results of the J-RHYTHM registry［J］.Circ J，2013，77（9）：2264-2270.3289
［23］中国医师协会心律学专业委员会心房颤动防治专家工作委，中华医学会心电生理和起搏分会.心房颤动：目前的认识和治疗建议——2015［J］.中华心律失常学杂志，2015，19（5）：321-384.DOI：10.3760/cma.j.issn.1007-6638.2015.05.001.3289
［24］张澍，杨艳敏，黄从新，等.中国心房颤动患者卒中预防规范［J］.中华心律失常学杂志，2015，19（3）：162-173.DOI：10.3760/cma.j.issn.1007-6638.2015.03.002.3289
ZHANG S，YANG Y M，HUANG C X，et al.Guideline of stroke prevention in Chinese patients with atrial fibrillation［J］.Chinese Journal of Cardiac Arrhythmias，2015，19（3）：162-173.DOI：10.3760/cma.j.issn.1007-6638.2015.03.002.3289
［25］《老年人心房颤动诊治中国专家建议》写作组，中华医学会老年医学分会，中华老年医学杂志编辑委员会.老年人非瓣膜性心房颤动诊治中国专家建议（2016）［J］.中华老年医学杂志，2016，35（9）：915-928.DOI：10.3760/cma.j.issn.0254-9026.2016.09.001.3289
［26］APOSTOLAKIS S，SULLIVAN R M，OLSHANSKY B，et al.
Factors affecting quality of anticoagulation control among patients with atrial fibrillation on warfarin：the SAMe-TT2R2 score［J］.Chest，2013，144（5）：1555-1563.DOI：10.1378/chest.13-0054.3289
［27］孙艺红，胡大一.非瓣膜病心房颤动患者全球抗凝注册研究中国亚组基线数据分析［J］.中华心血管病杂志，2014，42（10）：846-850.DOI：10.3760/cma.j.issn.0253-3758.2014.10.011.3289
SUN Y H，HU D Y.Chinese subgroup analysis of the global anticoagulant registry in the FIELD GARFIELD registry in the patients with non-valvular atrial fibrillation［J］.Chinese Journal of Cardiology，2014，42（10）：846-850.DOI：10.3760/cma.j.issn.0253-3758.2014.10.011.3289
［28］CHANG S S，DONG J Z，MA C S，et al.Current status and time trends of oral anticoagulation use among Chinese patients with nonvalvular atrial fibrillation：the Chinese Atrial Fibrillation Registry Study［J］.Stroke，2016，47（7）：1803-1810.DOI：10.1161/STROKEAHA.116.012988.3289
［29］HUISMAN M V，MA C S，DIENER H C，et al.Antithrombotic therapy use in patients with atrial fibrillation before the era of non-vitamin K antagonist oral anticoagulants：the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation （GLORIA-AF） Phase Ⅰ cohort［J］.Europace，2016，18（9）：1308-1318.DOI：10.1093/europace/euw073.3289
［30］秦明照，张雪松，赵森，等.666例老年非瓣膜病心房颤动抗凝治疗现况调查［J］.北京医学，2016，38（10）：975-979.DOI：10.15932/j.0253-9713.2016.10.003.3289
QIN M Z，ZHANG X S，ZHAO S，et al.Survey on anticoagulation therapy in 666 elderly patients with non-valvular atrial fibrillation［J］.Beijing Medical Journal，2016，38（10）：975-979.DOI：10.15932/j.0253-9713.2016.10.003.3289
［31］DONZé J，CLAIR C，HUG B，et al.Risk of falls and major bleeds in patients on oral anticoagulation therapy［J］.Am J Med，2012，125（8）：773-778.DOI：10.1016/j.amjmed.2012.01.033.3289
［32］FRANKEL D S，PARKER S E，ROSENFELD L E，et al.HRS/NSA 2014 survey of atrial fibrillation and stroke：gaps in knowledge and perspective，opportunities for improvement［J］.Heart Rhythm，2015，12（8）：e105-113.DOI：10.1016/j.hrthm.2015.04.039.3289
［33］GORST-RASMUSSEN A，SKJ?TH F，LARSEN T B，et al.Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis：a nationwide cohort study［J］.J Thromb Haemost，2015，13（4）：495-504.DOI：10.1111/jth.12845.3289
［34］LIN L J，CHENG M H，LEE C H，et al.Compliance with antithrombotic prescribing guidelines for patients with atrial fibrillation——a nationwide descriptive study in Taiwan［J］.Clin Ther，2008，30（9）：1726-1736.DOI：10.1016/j.clinthera.2008.09.010.3289
［35］FANG M C，GO A S，CHANG Y，et al.Warfarin discontinuation after starting warfarin for atrial fibrillation［J］.Circ Cardiovasc Qual Outcomes，2010，3（6）：624-631.DOI：10.1161/CIRCOUTCOMES.110.937680.3289
［36］WANG Z Z，DU X，WANG W，et al.Long-term persistence of newly initiated warfarin therapy in Chinese patients with nonvalvular atrial fibrillation［J］.Circ Cardiovasc Qual Outcomes，2016，9
（4）：380-387.DOI：10.1161/CIRCOUTCOMES.115.002337.3289
［37］徐宇红，孙勇.临床路径在心房颤动患者华法林抗凝治疗及健康教育中的应用［J］.中国实用护理杂志，2008，24（12）：13-15.DOI：10.3760/cma.j.issn.1672-7088.2008.12.006.3289
［38］LEFEBVRE M C，ST-ONGE M，GLAZER-CAVANAGH M，
et al.The effect of bleeding risk and frailty status on anticoagulation patterns in octogenarians with atrial fibrillation：the FRAIL-AF Study［J］.Can J Cardiol，2016，32（2）：169-176.DOI：10.1016/j.cjca.2015.05.012.3289
［39］BERTOZZO G，ZOPPELLARO G，GRANZIERA S，et al.Reasons for and consequences of vitamin K antagonist discontinuation in very elderly patients with non-valvular atrial fibrillation［J］.J Thromb Haemost，2016，14（11）：2124-2131.DOI：10.1111/jth.13427.3289
［40］MAZZONE A，BO M，LUCENTI A，et al.The role of comprehensive geriatric assessment and functional status in evaluating the patterns of antithrombotic use among older people with atrial fibrillation［J］.Arch Gerontol Geriatr，2016，65：248-254.DOI：10.1016/j.archger.2016.04.008.3289

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