Use of Warfarin at Discharge Among Acute Ischemic Stroke Patients With Nonvalvular Atrial Fibrillation in China
Use of Warfarin at Discharge Among Acute Ischemic Stroke Patients With Nonvalvular Atrial Fibrillation in China
复制标题
DOI：
10.1161/strokeaha.115.011833
复制
发表时间：
2016-02-01
期刊：
影响因子：
8.3
通讯作者：
Wang, Yongjun
中科院分区：
文献类型：
--
作者：
Yang, Xiaomeng;Li, Zixiao;Wang, Yongjun
背景和目的-指南推荐缺血性卒中伴房颤患者口服抗凝药物，而之前的研究表明中国此类患者抗凝药物使用不足。我们试图探讨潜在的原因和因素，目前影响使用华法林在China.Methods-From 2012年6月至2013年1月，19 604例急性缺血性脑卒中患者被纳入219个城市医院自愿参加中国国家卒中登记II。多变量Logistic回归模型，使用广义估计方程法，以确定患者/医院因素独立相关的华法林使用在dispersion.Results-Among 952例急性缺血性卒中患者的非瓣膜性房颤，19.4%出院华法林。出血风险（52.8%）和患者拒绝（31.9%）是不开抗凝药的主要原因。较大/教学医院更有可能处方华法林。老年患者、重度饮酒者、入院时国立卫生研究院卒中量表评分较高的患者不太可能服用华法林，而有心力衰竭病史且住院期间国际标准化比率在2.0至3.0之间的患者与出院时使用华法林显着相关。结论-中国缺血性卒中和已知非瓣膜性房颤患者的华法林使用率仍然较低。医院规模和学术地位以及患者年龄、心力衰竭、重度饮酒、住院国际标准化比率和入院时卒中严重程度均与出院时华法林的使用独立相关。中国非瓣膜病房颤患者卒中二级预防仍有很大的改进空间。
Background and Purpose-Guidelines recommend oral anticoagulation for ischemic stroke patients with atrial fibrillation, and previous studies have shown the underuse of anticoagulation for these patients in China. We sought to explore the underlying reasons and factors that currently affect the use of warfarin in China.Methods-From June 2012 to January 2013, 19 604 patients with acute ischemic stroke were admitted to 219 urban hospitals voluntarily participating in the China National Stroke Registry II. Multivariable logistic regression models using the generalized estimating equation method were used to identify patient/hospital factors independently associated with warfarin use at discharge.Results-Among the 952 acute ischemic stroke patients with nonvalvular atrial fibrillation, 19.4% were discharged on warfarin. The risk of bleeding (52.8%) and patient refusal (31.9%) were the main reasons for not prescribing anticoagulation. Larger/teaching hospitals were more likely to prescribe warfarin. Older patients, heavy drinkers, patients with higher National Institutes of Health Stroke Scale score on admission were less likely to be given warfarin, whereas patients with history of heart failure and an international normalized ratio between 2.0 and 3.0 during hospitalization were significantly associated with warfarin use at discharge.Conclusions-The rate of warfarin use remains low among patients with ischemic stroke and known nonvalvular atrial fibrillation in China. Hospital size and academic status together with patient age, heart failure, heavy alcohol drinking, international normalized ratio in hospital, and stroke severity on admission were each independently associated with the use of warfarin at discharge. There is much room for improvement for secondary stroke prevention in nonvalvular atrial fibrillation patients in China.