华法林与氯吡格雷预防心房纤颤患者缺血性脑卒中临床观察  

A clinical study of warfarin and clopidogrel in prevention of ischemic stroke in patients with nonvalvular atrial fibrillation

作　　者：赖金川[1] 李英[1] 姜荣建[1] 唐英蓉[1] 代红源[2] 

机构地区：[1]四川省人民医院心内科,成都610072 [2]四川省人民医院神经内科,成都610072

出　　处：《实用医院临床杂志》2005年第3期32-33,共2页Practical Journal of Clinical Medicine

摘　　要：目的对华法林与氯吡格雷预防心房纤颤患者缺血性脑卒中的作用进行比较.方法93例心房纤颤患者纳入研究.其中46例给予华法林治疗,国际标准化比率(INR)控制在1.8～2.5之间;47例给予氯吡格雷治疗.随访时间为2年,观察两组脑卒中、周围血管栓塞及出血事件的发生率.结果华法林组缺血性脑卒中总发生率低于氯吡格雷组(P=0.030).华法林组心源性脑栓塞发生率低于氯吡格雷组(P=0.026).结论华法林降低了房颤患者缺血性脑卒中及周围血管栓塞危险性且优于氯吡格雷,这一作用主要是通过降低心源性脑栓塞危险性实现的,但可能同时伴随有出血危险性的增加.Objective To compare the efficacy of warfarin and clopidogrel in prevention of ischemic stroke in patients with nonvalvular atrial fibrillation. Methods 93 patients with nonvalvular atrial fibrillation were assigned into 2 groups and were given warfarin or clopidogrel respectively for 2 years follow up. The dose of warfarin was adjusted to meet an INR range between 1.8～2.5, while clopidogrel was given routinely 75 mg/d. Results After 2 years follow up, the warfarin group showed a lower rate of ischemic stroke and peripheral embolism compared with the clopidogrel group (P =0.030) but had a higher rate of intracranial hemorrhage (P = 0.361) and other sites of bleeding events (P = 0.495). The warfarin group had a lower rate of cardiogenic cerebral embolism and peripheral vascular embolism than the clopidogrel group (P = 0.026 and P = 0.111, respectively). Conclusion Warfarin is superior to clopidogrel in prevention of ischemic stroke and peripheral embolism in patients with novalvular atrial fibrillation and this is achieved mainly by reducing the risk of cardiogenic cerebral embolism. At the same time, however, the risk of major bleeding is raised along with the use of warfarin.

关 键 词：缺血性脑卒中 氯吡格雷 心房纤颤 华法林 临床观察 预防 国际标准化比率 栓塞危险性 心源性脑栓塞 发生率 随访时间 出血事件 血管栓塞 周围血管 房颤患者 出血危险 治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R973.2[医药卫生—临床医学]