Objective To investigate the clinical features and current status of antithrombotic therapy in elderly patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD ) combined with non-valvular atrial fibrillation ( NVAF) ,and to analyze the existing problems in antithrombotic therapy. Methods We retrospectively analyzed the clinical data of 327 elderly patients with AECOPD complicated with NVAF who were hospitalized in respiratory department from January 2014 to December 2016. The risk of thromboembolism was assessed by CHA2DS2-VAScand HAS-BLED score,and the antithrombotic drugs and adverse reactions were analyzed. Results The average age of elderly AECOPD patients with NVAF was ( 82. 29 ± 5. 899 ) years,296 cases≥75 years old ( 90. 52%) . The average FEV1 was ( 40. 16 ± 10. 391 )%, and the average Paco2 was ( 70. 87 ± 9. 477)mmHg,with more complicated diseases. 323 cases(98. 8%) with CHA2DS2-VASc score ≥ 2,205 cases(62. 69%) with HAS-BLED score of 1~2. 96 cases were given antithrombotic therapy,including 71 cases with antiplatelet therapy(73. 96%)and 25 cases with anticoagulant therapy(26. 04%). The proportion of antithrombotic therapy in each year was low and did not increase significantly with the annual change,and the difference was not statistically significant(P>0. 05). 231 cases were not treated with antithrombotic therapy,the main reasons were lack of anticoagulant knowledge in 94 cases ( 40. 69%) , anxiety about monitoring trouble in 46 cases(19. 91%)and bleeding in 38 cases(16. 45%). Fecal occult blood was positive in 5 patients who took aspirin. One patient who took warfarin suffered from ecchymosis,and the rest had no adverse reactions. Conclusion The incidence of se-nile AECOPD with NVAF(especially in the elderly)is high,the disability rate is high,the risk of thrombus is high,the risk of bleeding is relatively low,and the anticoagulant therapy is seriously insufficient. In order to improve anticoagulant therapy in elderly patients with AECOPD combined with NVAF,we should strengthen the learning of NVAF knowledge among respiratory doctors and popularize NVAF knowledge to the patients.%目的 调查老年慢性阻塞性肺疾病急性加重(AECOPD)合并非瓣膜性房颤(NVAF)的临床特点和抗栓治疗现状,分析目前抗栓治疗存在的问题.方法 回顾性分析2014年1月至2016年12月呼吸科住院的327例老年AECO-PD合并NVAF患者的临床资料,进行血栓栓塞风险(CHA2DS2-VASc)评分和出血风险(HAS-BLED)评分,分析抗栓用药情况及不良反应.结果 老年AECOPD合并NVAF患者平均年龄(82.29±5.899)岁,≥75岁296例(90.52%).FEV 1平均为(40.16±10.391)%,PaCO2平均为(70.87±9.477)mmHg,合并疾病多.323例(98.8%)CHA2DS2-VASc评分≥2分,205例(62.69%)HAS-BLED评分1~2分.抗栓治疗96例(29.36%),其中抗血小板治疗71例(73.96%),抗凝治疗25例(26.04%),各年度抗栓治疗比例低且未随年度变化有明显增加,差异无统计学意义(P>0.05).231例未使用抗栓治疗,原因主要有医生缺乏抗凝知识94例(40.69%)、患者担心监测麻烦46例(19.91%)、患者担心出血38例(16.45%).5例服用阿司匹林发生大便隐血阳性.1例服用华法林皮肤出血散在瘀斑,其余病例未见不良反应.结论 老年AECOPD合并NVAF患者发病率高(尤其高龄老人)、致残率高、血栓风险高、出血风险相对较低、抗凝治疗严重不足.应加强呼吸科医生NVAF知识学习和向患者普及NVAF知识,从而提高老年AECOPD合并NVAF患者的抗凝治疗.
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