فراوانی درمان با انواع داروهای آنتی‌ترومبوتیک در مدیریت فیبریلاسیون دهلیزی غیر دریچه‌ای در بیماران پذیرش شده در بیمارستان

ﻣﻘﺪﻣﻪ: ﻓﯿﺒﺮﯾﻼﺳﯿﻮن دﻫﻠﯿﺰی، ﺷﺎﯾﻊ ﺗﺮﯾﻦ آرﯾﺘﻤﯽ ﭘﺎﯾﺪار ﻗﻠﺒﯽ اﺳﺖ و ﺑﺎ ﭘﯿﺶ آﻣﺪﻫﺎی ﻧﺎﻣﻄﻠﻮﺑﯽ ﻧﻈﯿﺮ ﺳﮑﺘﻪ ی ﻣﻐﺰی ﻫﻤﺮاﻫﯽ دارد. ﺗﺄﺛﯿﺮ درﻣﺎن ﻫﺎی ﺿﺪاﻧﻌﻘﺎدی در ﮐﺎﻫﺶ ﺧﻄﺮ اﺳﺘﺮوک ﺑﻪ ﺧﻮﺑﯽ ﻣﺸﺨﺺ اﺳﺖ وﻟﯽ ﻣﯿﺰان ﻓﺮاواﻧﯽ درﻣﺎن ﺑﺎ آﻧﺘﯽ ﮐﻮآﮔﻮﻻن ﻫﺎ در ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﻓﯿﺒﺮﯾﻼﺳﯿﻮن دﻫﻠﯿﺰی در ﺟﺎﻣﻌﻪ ی ﻣﺎ ﻧﺎﻣﺸﺨﺺ اﺳﺖ. ﻫﺪف از اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ﺑﺮرﺳﯽ ﺷﯿﻮع درﻣﺎن ﺑﺎ آﻧﺘﯽ ﮐﻮآﮔﻮﻻن و اﻧﻮاع ﻣﺨﺘﻠﻒ آن در ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﻓﯿﺒﺮﯾﻼﺳﯿﻮن دﻫﻠﯿﺰی ﺑﺴﺘﺮی ﺷﺪه در ﺑﯿﻤﺎرﺳﺘﺎن ﺑﻮد. روش ﻫﺎ: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ی ﻣﻘﻄﻌﯽ ﮔﺬﺷﺘﻪ ﻧﮕﺮ در ﻓﺎﺻﻠﻪ ی ﺳﺎل ﻫﺎی 1394 ﺗﺎ 1399 ﻗﺒﻞ از ﭘﺎﻧﺪﻣﯽ ﮐﻮوﯾﺪ-19 ، ﺗﻌﺪاد 200 ﺑﯿﻤﺎر ﺑﺎ ﻓﯿﺒﺮﯾﻼﺳﯿﻮن دﻫﻠﯿﺰی ﻏﯿﺮ درﯾﭽﻪ ای در دو ﮔﺮوه 100 ﻧﻔﺮی ﺑﺎ ﯾﺎ ﺑﺪون ﺣﻮادث آﻣﺒﻮﻟﯿﮏ اﺧﯿﺮ ﮐﻪ در ﺑﯿﻤﺎرﺳﺘﺎن اﻟﺰﻫﺮای اﺻﻔﻬﺎن ﺑﺴﺘﺮی ﺷﺪه ﺑﻮدﻧﺪ، ﺗﺤﺖ ﺑﺮرﺳﯽ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. در ﻫﺮ ﮔﺮوه، ﻧﻤﺮه ی cha2ds2-vasc score و ﻣﯿﺰان و ﻧﻮع آﻧﺘﯽ ﮐﻮآﮔﻮﻻن ﻣﺼﺮﻓﯽ ارزﯾﺎﺑﯽ ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: در 200 ﺑﯿﻤﺎر ﻣﯿﺎﻧﮕﯿﻦ ﺳﻨﯽ 70 ﺳﺎل، 55 درﺻﺪ زﻧﺎن ﺑﺮرﺳﯽ ﺷﺪه، ﺷﺎﯾﻊ ﺗﺮﯾﻦ ﺑﯿﻤﺎری ﻫﺎی ﻫﻤﺮاه دﯾﺎﺑﺖ و ﻓﺸﺎرﺧﻮن ﺑﻮد. اﺧﺘﻼف ﻣﻌﻨﯽ داری ﺑﯿﻦ ﻣﯿﺎﻧﮕﯿﻦ ﻧﻤﺮات cha2ds2-vasc score در دو ﮔﺮوه 3/8 در ﺑﺮاﺑﺮ 3/6 ﻣﺸﺎﻫﺪه ﻧﮕﺮدﯾﺪ. ﺳﺎﺑﻘﻪ ی ﻣﺼﺮف آﻧﺘﯽ ﮐﻮآﮔﻮﻻن در 48 درﺻﺪ از ﺑﯿﻤﺎران ﺑﺴﺘﺮی ﺑﺪون ﺳﺎﺑﻘﻪ ی ﺣﻮادث آﻣﺒﻮﻟﯿﮏ و ﻣﯿﺎﻧﮕﯿﻦ 3/6 :cha2ds2-vasc score وﺟﻮد داﺷﺖ.ﻧﺘﯿﺠﻪ ﮔﯿﺮی: ﺣﺪود ﻧﯿﻤﯽ از ﺑﯿﻤﺎراﻧﯽ ﺑﺴﺘﺮی ﺑﺪون ﺣﻮادث آﻣﺒﻮﻟﯿﮏ و ﺗﻘﺮﯾﺒﺎً ﯾﮏ ﺳﻮم ﺑﯿﻤﺎران ﺑﺴﺘﺮی ﺷﺪه ﺑﺎ ﺣﻮادث آﻣﺒﻮﻟﯿﮏ ﺳﺎﺑﻘﻪ ی درﯾﺎﻓﺖ داروﻫﺎی ﺿﺪاﻧﻌﻘﺎدی، ﻋﻤﺪﺗﺎً وارﻓﺎرﯾﻦ، داﺷﺘﻨﺪ. در ﻣﺒﺘﻼﯾﺎن ﺑﻪ ﻓﯿﺒﺮﯾﻼﺳﯿﻮن دﻫﻠﯿﺰی، ﺑﺎ وﺟﻮد ﻟﺰوم درﯾﺎﻓﺖ آﻧﺘﯽ ﮐﻮآﮔﻮﻻن ﺑﺮای ﭘﯿﺸﮕﯿﺮی از ﺳﮑﺘﻪ ی ﻣﻐﺰی، از ﺟﻤﻠﻪ اﻓﺮاد ﺑﺎ cha2ds2-vasc score ﺑﺎﻻ، ﻣﯿﺰان ﻣﺼﺮف ﻣﻬﺎرﮐﻨﻨﺪه ﻫﺎی ﻣﺴﺘﻘﯿﻢ ﺗﺮوﻣﺒﯿﻦ، در ﺣﺪ ﺑﺴﯿﺎر ﭘﺎﯾﯿﻦ دﯾﺪه ﺷﺪ.

the frequency of antithrombotic therapy in management of non-valvular atrial fibrillation in hospitalized patients

background: atrial fibrillation is the most common sustained arrhythmia and is associated with poor outcomes, including stroke. the ability of anticoagulation therapy to reduce the risk of stroke has been well established; however, the frequency of anticoagulation therapy uses is unknown in our community. this study aims to evaluate the frequency of anticoagulation therapy and its different types among patients with atrial fibrillation.methods: in this cross-sectional study between april 2015 to april 2016 (before the covid-19 pandemic), a number of 200 patients with non-valvular atrial fibrillation, in two groups of 100 patients with and without recent embolic events were studied who were hospitalized in al-zahra hospital in isfahan. the cha2ds2-vasc score and the amount and type of anticoagulant usage were evaluated in each group.findings: in included 200 patients (mean age 70 years, 55% women), hypertension and diabetes were the most prevalent diseases. there was no significant difference in the mean of the cha2ds2-vasc score between the two groups; 3.8 vs 3.6. (p > 0.05). there was a history of anticoagulant use in 48% of the patients hospitalized without embolic events and a mean cha2ds2-vasc score: of 3.6.conclusion: about half of the hospitalized patients without embolic events and one-third of the patients with embolic events took anticoagulants for thromboembolic prevention, mostly warfarin. in patients with atrial fibrillation, despite the need to receive anticoagulants to prevent stroke, including people with a high cha2ds2-vasc score, the consumption of direct thrombin inhibitors was seen at a very low level.