Objective To assess compliance and instability of anticoagulation level in outpatients on oral anticoagulant therapy. Methods Five hundred and eighty three patients with nonvalvular atrial fibrillation from eight general hospitals and seven community health service centers which allocated in eight districts in Beijing city were questioned by physicians. Subjects who were prescribed warfarin treatment were followed up 2 times between March 2008 and April by telephone. Results One hundred and ten of these S83 patients(18.9%) and 85 of 466 patients(18.2% ) at high stroke risk took warfarin. Twenty nigh point two percent of patients achieved the therapeutic INR value in 3 months, and 44.7% achieved the INR target in 1 year. Eighty four of 105 patients(80% ) continue to take warfarin lyear later. Of those patients giving up treatment, 67. 8% of them stopped treatment within 6 months. Over 20% of patients monitored INR value at most once every 3 months. Conclusions The utility of anticoagulation treatment is low in outpatients with nonvalvular atrial fibrillation especially in patients at high stroke risk. The compliance of monitor is poor. Patient education should be done to increase the compliance of anticoagulation treatment.%目的 了解门诊心房颤动(房颤)患者抗凝治疗的依从性,提高抗凝治疗质量,预防缺血性脑卒中.方法 从北京市城八区选择8所三级医院和7所二级医院,由内科医生对门诊或病房非瓣膜性房颤患者采取统一问卷调查.对抗凝治疗患者分别于调查结束后1年和2年进行随访,了解患者治疗的依从性和效果.结果 583例非瓣膜性房颤患者中110例服用华法林,华法林总体服用率为18.9%,脑卒中高危房颤患者抗凝治疗率为18.2%(85例).开始治疗后3个月国际标准化测量值(INR)达标率为29.2%(7例),超过1年达标率为44.7%(21例).1年随访时服药治疗依从性为80.0%(84例),放弃抗凝治疗的患者中67.8%(19例)在开始治疗的6个月内停药.患者监测依从性较差,23.8%(20例)患者超过2个月监测1次INR值.结论 门诊房颤患者尤其是脑卒中高危房颤患者抗凝治疗率低,抗凝治疗依从性较高,监测依从性有待提高,加强抗凝治疗患者的随访教育尤其是开始治疗后的早期随访教育有助于提高抗凝治疗的依从性.
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