非瓣膜病房颤患者口服新型抗凝药依从性的调查

doi:10.3761/j.issn.0254-1769.2019.06.014

中华护理杂志 ›› 2019, Vol. 54 ›› Issue (6): 878-881.DOI: 10.3761/j.issn.0254-1769.2019.06.014

非瓣膜病房颤患者口服新型抗凝药依从性的调查

伍珊珊,黄远平,谢铄,徐颖洁,王丽姿()

510280 广州市南方医科大学珠江医院心内科

收稿日期:2018-07-25 出版日期:2019-06-15 发布日期:2019-06-15
通讯作者: 王丽姿
作者简介:伍珊珊：女,本科(硕士在读),护士,E-mail： <email>wu33718@163.com</email>
基金资助:
南方医科大学护理科研专项资金(Y2017001)

Adherence and associated factors of non-vitamin K antagonist oral anticoagulants therapy in patients with non-valvular atrial fibrillation

WU Shanshan,HUANG Yuanping,XIE Shuo,XU Yingjie,WANG Lizi()

Received:2018-07-25 Online:2019-06-15 Published:2019-06-15
Contact: Lizi WANG

摘要/Abstract

摘要：

目的调查非瓣膜病房颤患者服用新型口服抗凝药的依从性及其影响因素,并分析停药原因。方法采用便利抽样法,对2016年3月—2018年3月某三级甲等医院服用新型口服抗凝药的133例非瓣膜病房颤患者进行调查,统计患者持续服药时间、停药原因和不良事件发生率。采用Kaplan-Meier法和Cox回归分析患者服用新型口服抗凝药的依从性及影响因素。结果服用达比加群酯和利伐沙班的患者分别为101例(75.9%)和32例(24.1%)。患者持续服药中位时间为182 d,达比加群酯和利伐沙班的持续服药中位时间分别为182 d和305 d。生存分析显示,患者在3个月、6个月和1年时仍坚持服药的累积比例分别为72.5%,50.6%和32.3%。阵发性房颤、无心力衰竭和无脑卒中史是服药依从性差的主要因素,患者自行停药是抗凝终止的首要原因。结论非瓣膜病房颤患者服用新型口服抗凝药的依从性差,服药3~6个月时需加强关注,提示应进行多学科合作,对阵发性房颤、无心力衰竭和无脑卒中史的患者加强抗凝管理,改善抗凝质量。

关键词: 心房颤动, 非维生素K拮抗剂口服抗凝药, 达比加群酯, 利伐沙班, 服药依从性

Abstract:

Objective To investigate adherence and associated factors of non-vitamin K antagonist oral anticoagulants(NOACs) therapy,as well as reasons of discontinuance in patients with non-valvular atrial fibrillation(NVAF).Methods By convenience sampling,133 patients with NVAF on NOACs therapy from March 2016 to March 2018 were followed up to collect data about duration of anticoagulation,reasons for cessation and adverse events. Kaplan-Meier and Cox regression were used to explore adherence of NOACs and associated factors.Results One hundred and one(75.9%)and 32(24.1%) patients took dabigratran and rivaroxaban,respectively. The duration of anticoagulation in patients was 182 days. The duration time in patients taking dabigratran and rivaroxaban were 182 and 305 days,respectively. Survival table showed that the cumulative proportion of patients still taking the medicine at 3 months,6 months and 1 year was 72.5%,50.6% and 32.3%. Patients with paroxysmal AF,no heart failure and no stroke were associated with poor adherence of NOACs. Patient preference was the main reason for anticoagulant cessation.Conclusion Adherence of NOACs in patients with NVAF is poor with high rate of drug cessation. Multidisciplinary cooperation is needed for patients with paroxysmal AF,no heart failure and no stroke,to strengthen anticoagulation management and follow-up at the peak of drug discontinuation for the purpose of improving the quality of anticoagulation.

Key words: Atrial Fibrillation, Non-vitamin K Antagonist Oral Anticoagulants, Dabigatran, Rivaroxaban, Medication Adherence

伍珊珊, 黄远平, 谢铄, 徐颖洁, 王丽姿. 非瓣膜病房颤患者口服新型抗凝药依从性的调查[J]. 中华护理杂志, 2019, 54(6): 878-881.

WU Shanshan, HUANG Yuanping, XIE Shuo, XU Yingjie, WANG Lizi. Adherence and associated factors of non-vitamin K antagonist oral anticoagulants therapy in patients with non-valvular atrial fibrillation[J]. Chinese Journal of Nursing, 2019, 54(6): 878-881.

参考文献 19

[1]	吴楠, 顾晴, 关玉霞 , 等. 心房颤动患者华法林抗凝治疗的管理现状[J]. 中华护理杂志, 2014,49(3):440-443.
[2]	冯慧琴, 黄丽霞, 黄翯 , 等. 21例老年非瓣膜病性心房颤动患者使用华法林抗凝的随访管理[J]. 中华护理杂志, 2013,48(1):78-79.
[3]	中华医学会心血管病学分会, 中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会. 非瓣膜病心房颤动患者新型口服抗凝药的应用中国专家共识[J]. 中华心律失常学杂志, 2014,18(5):321-329.
[4]	Ruff CT, Giugliano RP, Braunwald E , et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation:a meta-analysis of randomised trials[J]. Lancet, 2014,383(9921):955-962. DOI URL
[5]	Kirchhof P, Benussi S, Kotecha D , et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS[J]. Europace, 2016,18(11):1609-1678. DOI URL
[6]	Osterberg L, Blaschke T . Adherence to medication[J]. N Engl J Med, 2005,353(5):487-497. DOI URL
[7]	Steffel J, Verhamme P, Potpara TS , et al. The 2018 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation[J]. Eur Heart J, 2018,39(16):1330-1393. DOI URL
[8]	孙振球, 徐勇勇 . 医学统计学[M]. 北京: 人民卫生出版社, 2014.
[9]	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.
[10]	Cramer JA, Roy A, Burrell A , et al. Medication compliance and persistence:terminology and definitions[J]. Value Health, 2008,11(1):44-47. DOI URL
[11]	Wang 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 URL
[12]	Gorst-Rasmussen A, Skjøth F, Larsen TB , et al. Dabigatran adhe-rence in atrial fibrillation patients during the first year after diagnosis:a nationwide cohort study[J]. J Thromb Haemost, 2015,13(4):495-504. DOI URL
[13]	Shiga T, Naganuma M, Nagao T , et al. Persistence of non-vitamin K antagonist oral anticoagulant use in Japanese patients with atrial fibrillation:a single-center observational study[J]. J Arrhythm, 2015,31(6):339-344. DOI URL
[14]	Beyer WJ, Forster K, Ebertz F , et al. Drug persistence with rivaroxaban therapy in atrial fibrillation patients—results from the Dresden non-interventional oral anticoagulation registry[J]. Europace, 2015,17(4):530-538. DOI URL
[15]	Clarkesmith DE, Pattison HM, Lip GY , et al. Educational inter-vention improves anticoagulation control in atrial fibrillation patients:the TREAT randomised trial[J]. PloS one, 2013,8(9):e74037. DOI URL
[16]	Vanassche T, Lauw MN, Eikelboom JW , et al. Risk of ischae-mic stroke according to pattern of atrial fibrillation:analysis of 6563 aspirin-treated patients in ACTIVE-A and AVER-ROES[J]. Eur Heart J, 2015,36(5):281-288. DOI URL
[17]	高鹏, 方全, 王佳丽 , 等. 非瓣膜病心房颤动患者抗凝不足状况及原因分析[J]. 中华心血管病杂志, 2013,41(11):931-934.
[18]	Abraham JM, Connolly SJ . Atrial fibrillation in heart failure:stroke risk stratification and anticoagulation[J]. Heart Fail Rev, 2014,19(3):305-313. DOI URL
[19]	Brien EC, Simon DN, Allen LA , et al. Reasons for warfarin discontinuation in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation(ORBIT-AF)[J]. Am Heart J, 2014,168(4):487-494. DOI URL

非瓣膜病房颤患者口服新型抗凝药依从性的调查

Adherence and associated factors of non-vitamin K antagonist oral anticoagulants therapy in patients with non-valvular atrial fibrillation

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