华法林在慢性心房颤动抗凝治疗中的应用  

Clinical study of anticoagulation with warfarin in patients with chronic atrial fibrillation

作　　者：黄维义[1] 李刚[1] 严丽[1] 彭永权[1] 罗兴林[1] 

机构地区：[1]泸州医学院附属医院心内科,四川泸州646000

出　　处：《临床心血管病杂志》2006年第5期276-278,共3页Journal of Clinical Cardiology

摘　　要：目的:探讨华法林在慢性心房颤动(CAf)抗凝治疗中的合理应用。方法:共入选234例具有血栓栓塞高风险的CAf患者,给予华法林抗疑治疗,监测国际标准化比值(INR)以调整华法林用量,随访观察华法林的不同起始剂量、不同的抗凝强度以及高龄(≥65岁)等因素对INR达标时间、INR稳定值、华法林维持量、出血率及栓塞率的影响。结果:分别采用开始剂量为普通剂量(2．5mg／d)与小剂量(1．25 mg／d)2种方式,两者最终获得稳定的INR、华法林维持量及出血率均差异无统计学意义,但前者能明显缩短INR首次达标时间及获得INR 稳定值的时间(均P<0．01),并有降低栓塞率的趋势;与低强度抗凝相比,中强度抗凝能显著降低栓塞率(P< 0．05),虽然伴出血率明显升高(P<0．05),但无严重出血发生;在相同的目标INR内,高龄患者出血率并不增加,但所需的华法林维持量有所降低(P<0．01)。结论:以普通量的华法林开始CAf抗凝治疗是安全的,抗栓塞效果优于小剂量;对具有栓塞高风险的CAf需保持中强度抗凝水平;华法林抗凝治疗并不增加高龄患者的出血风险。Objective：To explore the reasonable use of warfarin for antieoagulation in patients with chronic atrial fibrillation（CAF）. Method：Total 234 CAf patients at high risk of stroke received anticoagulation with warfarin. The changes of time of reaching the target international normalised ratio （INR）, the INR value, the maintain dosage of warfarin and the average annual rates for bleeding events and embolic events affected by such factors as different initial dosage of warfarin, different intensity of anticoagulation and fenility （age ≥65 ） were observed. Result：Compared with the small initial dosage（1.25 mg/d） of warfarin group, the common initial dosage（2.5 mg/ d） of warfarin group reached the target INR and the stable INR with shorter time （ P 〈0. 01, respectively） and tended to decrease the rate of embolic, but the INR value, the maintain dosage of warfarin and the bleeding rate showed no difference. Compared with the low intensity of anticoagulation group, the middle intensity of anticoagulation group could significantly decrease the rate of embolic（ P 〈0. 05）. Although it increased the rate of bleeding （ P d0.05）, there were no serious bleeding events; The elderly （age≥65） didn＇t show higher bleeding rate but need less maintain dosage of warfarin （ P 〈0. 01） to keep the target INR. Conclusion：Its better to antlcoagulate with common initial dosage of warfarin in patients with CAf. patients with CAf at high risk of stroke should be given middle intensity of antieoagulation. Anticoagulating with warfarin didfft increase the bleeding risk in the elderly （age≥65）.

关 键 词：心房颤动 华法林 抗凝治疗 

分 类 号：R542.1[医药卫生—心血管疾病]