摘要
目的评估中国缺血性卒中(IS)或短暂性脑缺血发作(TIA)患者应用抗血栓药物(包括抗血小板药物和抗凝药物)的现况,并分析其影响因素。方法采用横断面研究方法,调查2006年7月1日至8月15日期间,中国主要城市二、三级医院神经内科门诊连续IS或TIA患者近期的抗血栓药物使用情况。22家医院参加调查,总计2384例卒中患者连续入选;有3家不符合中心入选标准被除外,最后19家医院的资料被采用,总计有2283例卒中患者的数据纳入分析中。结果2283例卒中患者中,使用阿司匹林者占71.9%,使用阿司匹林+氯吡格雷占4.2%,使用氯吡格雷者占7.3%,各种抗血小板药物合计例数占75.6%。伴心房颤动的81例卒中患者中,使用华发林者占17.3%。医疗保险[比值比(OR)1.473,95%可信区间(CI)1.088～1.994]、公费医疗(OR 1.632,95%CI 1.029～2.589)、月均收入≥500元以上(OR 2.136,95% CI 1.508～3.026)、高血压(OR 1.463,95% CI 1.159～1.847)和脂代谢紊乱(OR1.499,95% CI1.187～1.893)是卒中患者接受抗血小板药物的促进因素。患者年龄≥75岁(OR 0.701,95% CI 0.498～0.988)及改良的Rankin评分4～5分(OR 0.684,95% CI 0.486～0.965)是用药的阻碍因素。结论中国大城市二、三级医院IS和TIA患者的抗血栓治疗现状不容乐观,各类抗血栓药物应用的比例较低,为改善以上状况,亟待探索有效的改进模式,缩短临床实践与指南间的差距。
Objective To assess the current status of antithrombotic drug use (including anticoagulant agents and antiplatelet drugs) in patients with ischemic stroke(IS) or transient ischemic attack(TIA) in China and to analyze the possible factors that may affect the use of these drugs. Methods A cross-sectional survey was performed to investigate the administration of antithrombotic drugs in patients with IS or TIA from July 01 to August 15, 2006. All subjects selected for the study represented consecutive cases diagnosed with IS or TIA at neurological clinics in major metropolitan cities in China. A total of 2283 IS or TIA patients from 19 hospitals were included in the survey. Results Among 2283 patients, 75.6% were treated with antiplatelet drugs. A total of 71.9% patients used aspirin, 4.2% used aspirin + clopidogrel, and 7.3% used clopidogrel. In addition, 81 of the IS or TIA patients had atrial fi brillation (AF), and 17.3% of these patients were treated with warfarin. Medical insurance (odds ratio [OR] 1.473, 95% conf idence interval [CI] 1.088–1.994), Medicaid (OR 1.632, 95%CI 1.029–2.589), monthly income greater than RMB 500 yuan (OR 2.136, 95% CI 1.508– 3.026), hypertension (OR 1.463, 95%CI 1.159–1.847), and lipid metabolism disorders (OR 1.499, 95% CI 1.187–1.893) were predictors of antiplatelet drug treatment. In contrast, an age of 75 years or older (OR 0.701, 95% CI 0.498–0.988) and a modif ied Rankin Scale (mRS) score of 4–5 (OR 0.684, 95% CI 0.486–0.965) were predictors of antiplatelet drug non-use. Conclusion Current status of antithrombotic treatment among IS or TIA patients in the hospitals of major metropolitan cities in China is inadequate. Effective strategies must be implemented to close the gap between clinical guidelines and practice.
出处
《中国卒中杂志》
2007年第4期301-307,共7页
Chinese Journal of Stroke
基金
北京市科学技术委员会重大项目(D0905004040231)
阿斯利康制药有限公司"HINT"项目资助
关键词
卒中
抗栓治疗
二级预防
医疗服务
Stroke
Antithrombotic
Secondary Prevention
Healthcare Service
