老年慢性非瓣膜房颤患者的抗凝治疗  

Anticoagulant treatment on chronic non-valvalar atrial fibrillation in the elderly patients

作　　者：卢燕玲[1] 张金荣[1] 

机构地区：[1]北京安贞医院心内科,北京100029

出　　处：《中华急诊医学杂志》2006年第1期54-56,共3页Chinese Journal of Emergency Medicine

摘　　要：目的比较肠溶阿司匹林和结晶华法林对慢性非瓣膜房颤的老年患者预防缺血性脑卒中的疗效。方法老年慢性非瓣膜性房颤患者431例,年龄>65岁,随机分为阿司匹林、华法林两组对照试验,服用2年,观察脑卒中和出血的发生率。结果年龄65～74岁没有危险因素的房颤患者脑卒中的发生率肠溶阿司匹林组为2.9%、华法林组为1.7%,差异无明显性(P>0.05);年龄65～74岁有危险因素的房颤患者脑卒中的发生率肠溶阿司匹林组为5.2%,明显高于华法林组2.1%。年龄≥75岁没有危险因素的患者,脑卒中发生率阿司匹林组4.9%明显高于华法林组2.3%;年龄≥75岁有危险因素的患者,脑卒中发生率阿司匹林组6.7%,明显高于华法林组2.2%(P<0.05)。出血并发症发生率阿司匹林3.06%、华法林组2.76%,两组比较差异无显著性(P>0.05)。结论年龄65～74岁没有危险因素的非瓣膜房颤患者可服用阿司匹林预防脑卒中。而对于年龄≥75岁以及所有有危险因素的患者须服用华法林预防脑卒中,华法林在抗凝同时没有增加出血的并发症。Objective To compare the effects of aspirin and warfarin in the elderly patients with chronic nonvalve atrial fibrillation. Methods 431 elderly patients with chronic non-valvalar atrial fibrillation were randomly divided into two groups： group A received aspirin; group B received warfarin. After patients were treated with aspirin or warfarin for two years, the incidence rate of stroke and hemorrhage rate were counted. Results Aspirin was as effective as warfarin in preventing stroke in patients age 65 to 75 years old without risk factor, and warfarin was more effective than aspirin in preventing stroke in patients （ ≥ 75） and all patients with risk factors. Warfarin and aspirin had low incidence rate of bleeding. Conclusion For the patients aged 65 to 75 years aid have no risk factors, they should be treated with aspirin in preventing stroke . For the older patients older than 75 years old and patients have risk factors, they should be treated with warfarin, which is more effieient than asprin in preventing stroke.

关 键 词：肠溶阿司匹林 华法林 房颤 抗凝 

分 类 号：R541.75[医药卫生—心血管疾病] R256.340.5[医药卫生—内科学]