Current Status and Clinical Effectiveness of Anticoagulant Therapy for In-hospital Patients With Acute Coronary Syndromes at County Hospitals of China
10.3969/j.issn.1000-3614.2016.06.004
- VernacularTitle:我国县级医院急性冠状动脉综合征患者住院期间抗凝药物应用情况及临床效果分析
- Author:
Boya SUN
;
Yangfeng WU
;
Yihong SUN
;
Shenshen LI
;
Xian LI
;
Min LI
;
Aihua ZHANG
;
Tao WU
;
Xin DU
;
Lingzhi KONG
;
Yong HUO
;
Dayi HU
;
Runlin GAO
- Publication Type:Journal Article
- Keywords:
Acute coronary syndromes;
Anticoagulants;
In-hospital mortality;
Severe bleeding events
- From:
Chinese Circulation Journal
2016;31(6):536-540
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To analyze the current status of anticoagulant therapy for in-hospital patients with acute coronary syndromes (ACS) at county hospitals of China and to explore the relationship between anticoagulant therapy and clinical outcomes in real medical environment. Methods: 99 county hospitals from15 provinces of China were selected for this prospective registry study and 12373 eligible ACS patients without interventional therapy admitted from 2011-09 to 2014-06 were enrolled. The basic condition, previous history, initial assessment, anticoagulants (unfractionated heparin/low molecular weight heparin) application, severe bleeding events and in-hospital mortality were collected in all patients. Multiple logistic regression analysis was conducted to explore the relationship between anticoagulant therapy and clinical outcomes including in-hospital mortality, severe bleeding events and combined endpoints; meanwhile, possible confounders were adjusted. Results: A total of 9985/12373 ACS patients received anticoagulant therapy and 2388 did not. Anticoagulant therapy was conducted in 92.7% (4237/4570) patients with ST-segment elevation myocardial infarction (STEMI), 90.8% (1639/1805) with non-ST-segment elevation myocardial infarction (NSTEMI) and 68.5% (4109/5998) with unstable angina (UA); there were differences by regions and genders,P<0.01and no difference by age. Multivariable analysis indicated that anticoagulant therapy decreased the risk of in-hospital mortality in ACS patients at 53% (OR= 0.47, 95% CI 0.36-0.62), such reduction in STEMI patients was at 55% (OR=0.45, 95% CI 0.32-0.64), in NSTEMI patients was at 58% (OR=0.42, 95% CI 0.24-0.75); while it had no real effect in UA patients,P>0.05. Meanwhile, it did not increase the risk of severe bleeding events in ACS patients,P>0.05. Conclusion: Anticoagulant therapy has been widely used in STEMI and NSTEMI patients at county hospitals of China and obviously decreased the in-hospital mortality; while the application rate was relatively low in UA patients. The general safety of anticoagulant therapy has been good in ACS patients.
