研究背景
雖然國際準則建議心房顫動病患中具高度中風危險性的患者應使用warfarin作為預防，但各國調查warfarin的使用率仍然偏低。本研究的目的為：研究臺灣地區心房顫動病患使用抗血栓劑與ACC/AHA/ ESC心房顫動準則(2001)建議之一致性，並找出影響心房顫動患者處方抗血栓劑的因子。

研究方法
本研究納入全民健康保險資料庫2003年7月1日至2004年6月30日期間，門、住診曾經出現兩次「427.31」診斷碼的心房顫動病患，分析其抗血栓劑的使用情形，並利用單變項分析及邏輯複回歸分析找出影響與準則的一致性以及抗血栓劑處方的因子。

研究結果
研究最終納入39541人，其中90%的患者為高度中風危險性以上；抗血栓劑的使用與ACC/AHA/ESC(2001)準則的一致性僅24.7%，即使扣除有出血危險因子的患者，與準則一致性仍只有26％。影響warfarin處方的因素，除了出血危險因子以外，高血壓、冠狀動脈疾病以及年齡增加都會降低warfarin的處方機會不同。不同醫師專科別中與準則配合度以心臟外科最佳，其次為神經內科、心臟內科、其他專科、家醫科以及一般內科；醫院層級越高，與準則配合程度越好。

結論
臺灣地區心房顫動的患者並未接受適當的抗血栓劑預防中風。病患罹病特性、醫師專科以及醫院層級皆會影響抗血栓劑的處方。

Introduction
Although the value of warfarin in preventing thromboembolic events in atrial fibrillation (AF) patients has been well established, the prescribing rate of warfarin was still under expected. The objectives of this study were to evaluate the adherence rate with antithrombotic guideline (ACC/AHA/ ESC 2001) in Taiwan and to identify factors affecting the antithrombotic therapy.
Methods
We included AF patients who were documented with ICD9-CM coded of “42731” twice in non-sampled NHI claim database from 1 July 2003 through 30 June 2004. Utilization of antithrombotic therapy among these patients was analyzed. Univariate and multiple logistic regressions were performed to identify factors associated with antithrombotic therapy and guideline adherence.
Results
Among 39541 AF patients, up to 90% were identified with high risk of thromboembolic events. Only 24.7% of them had received the appropriate antithrombotic therapy. As we had excluded patients with bleeding risk factors, the adherence rate was still 26%. Other than bleeding risk factors, hypertension, coronary heart disease and increased age presented an inverse association with warfarin use. Among physician’s specialty, cardiac surgeons were most likely to adhere to the Guideline, followed by neurologist, cardiologist, other specialist, family physician and other internist. Patients were more likely to receive appropriate antithrombotic therapy when the hospital level was higher.
Conclusion
Most AF patients in Taiwan did not receive appropriated antithrombotic therapy. Patient’s comobidity, physician’s specialty and hospital level all had influenced on the prescription of antithrombotic therapy.

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