华法林低强度抗凝对高龄老年非瓣膜病性心房颤动抗栓治疗的安全性  

The safety of lower anticoagulate intensity of warfarin in treating nonvalvular atrial fibrillation in elderly patients

作　　者：武云涛[1] 高迎春 刘立新[1] 陈艳梅[1] 查政[1] 吕明芳[1] 曹丹阳[1] 毕磊[1] 曹晶晶[1] 

机构地区：[1]北京军区总医院干一科,100700 [2]内蒙古自治区人民医院心血管内科

出　　处：《中华保健医学杂志》2010年第4期255-257,共3页Chinese Journal of Health Care and Medicine

摘　　要：目的研究低抗凝强度的华法林治疗高龄老年非瓣膜病性永久性心房颤动(NVAF)患者血栓形成的安全性。方法入选NVAF患者按年龄分为两组:高龄老年组40例,年龄≥80岁,平均84.50±4.05岁,老年组40例,年龄60～79岁,平均74.50±4.00岁。两组采用华法林低强度抗凝,目标范围为国际标准化比值(INR)1.6～2.5。随访1年,观察两组患者用药的不良反应和华法林的安全用量范围。结果 INR在1.6～2.5时高龄老年组和老年组华法林维持剂量分别为1.25～3.75mg/d,平均2.86±0.62mg/d和1.88～3.75mg/d,平均2.66±0.12mg/d。INR在安全范围内华法林的用量两组比较无统计学差异。两组患者均未发现严重出血,高龄老年组与老年组分别发生轻度牙龈出血6例和7例、皮下淤血各3例、尿常规检查有红细胞2例和1例,粪便潜血弱阳性3例和2例;两组出血发生率差异无统计学意义(P>0.05)。两组患者均无新的血栓栓塞事件发生。结论严密监测INR下调整华法林剂量对高龄老年NVAF患者治疗的安全性好。Objective To study the safety of warfarin in treating nonvalvular atrial fibrillation（NVAF）in elderly patients,and to titrate safe dosage of Warfarin.Methods The NVAF patients were divided into 2 groups by age,inculding the oldest old group（n=40,age ≥80year,84.50±4.05）,old group（n=40,age of 60～79,74.50±4.00）.Low anticoagulate intensity of Warfarin（INR 1.6～2.5）was used by the 2 groups;INR was tested before treatment（initial dose was 2.5 mg/d,and then it was adjusted according to INR）,on the 1st day、3rd day、7th day after treatment,and tested once a week to once a month later,follow up for 1 year.The safety range of warfarin,the risk of upper gastrointestinal bleeding and other adverse effects were observed in the 2 groups.Results Warfarin maintenance dose was 1.25～3.75 mg/d,average（2.86±0.62）mg/d,in oldest old group,it was 1.875～3.75 mg/d,average（2.66± 0.12）mg/d in old age group when the INR achieved 1.6～2.5.There was no statistical difference between the two groups.No serious bleeding occurred in two groups.Mild gingival bleeding occurred to 6 cases in oldest old group and 7 cases in old age group.Subcutaneous ecchymosis was 3 cases in two groups.Red blood cells were positive in urine tests of 2 cases in oldest old group and 1 case in old age group.Faecal occult blood was weakly positive of 3 cases in oldest old group and 2 cases in old age group.There was no significant difference in hemorrhagic in 2 groups（P〉0.05）.Conclusions Adjusted dose warfarin to low anticoagulate intensity is safe for treating NVAF in elderly patients.

关 键 词：非瓣膜病性心房颤动 抗凝 华法林 国际标准化比率 

分 类 号：R541.75[医药卫生—心血管疾病]