双重抗血小板与华法林预防低危非瓣膜性心房颤动患者血栓栓塞的对照研究  

Comparison of dual-antiplatelet treatment with warfarin for the prevention of thromboembofism in low risk patients with nonvalvular atrial fibrillation

作　　者：耿清峰[1] 李梅茹[1] 李红月[1] 任宏伟[1] 王斌[2] 安树章[1] 成丽娟[1] 齐建立[1] 刘玉惠[1] 杨永利[1] 常顺[1] 

机构地区：[1]河北省第七人民医院心内科,定州073000 [2]北京大学航天临床医学院心内科

出　　处：《中国心血管杂志》2010年第5期347-349,共3页Chinese Journal of Cardiovascular Medicine

基　　金：河北省科技攻关计划项目(052761692)

摘　　要：目的 比较阿司匹林联合双嘧达莫与华法林预防低危非瓣膜性心房颤动（NVAF）患者血栓栓塞的有效性和安全性.方法 将确诊的125例低危NVAF患者,采用机械抽样法随机分为两组,分别给予调整剂量华法林抗凝治疗[华法林组,69例,目标国际标准化比值（INR）为2.0～3.0]和阿司匹林联合双嘧达莫抗血小板治疗（联合治疗组,56例,阿司匹林100 mg 1次/d＋双嘧达莫100 mg 3次/d）.观察两组患者死亡、血栓栓塞事件（缺血性脑卒中和外周动脉栓塞）及各种出血的发生率.结果 随访12～28个月.华法林组失访3例,发生缺血性脑卒中1例,严重出血1例,轻微出血3例 联合治疗组失访2例,发生缺血性脑卒中2例,周围动脉栓塞1例,轻微出血2例,无严重出血病例.与联合治疗组相比,华法林组血栓栓塞事件发生率具有降低趋势,但差异无统计学意义[1.5%（1/66）比5.6%（3/54）,P=0.220] 出血事件发生率呈现升高趋势,但差异也无统计学意义[6.1%（4/66）比3.7%（2/54）,P=0.556].结论 无血栓栓塞高危因素的低危NVAF患者,阿司匹林联合双嘧达莫抗血小板治疗与口服华法林抗凝治疗的疗效相似.Objective To compare the efficacy and safety of aspirin/dipyridamole with warfarin for thromboembolism prevention in nonvalvular atrial fibrillation （NVAF） patients with low cardiovascular risk. Methods One hundredand twenty five NVAF patients with low cardiovascular risk were randomly allocated into two groups： dose- adjusted warfarin group [ 69 cases with a target international normalized ratio （INR） of 2. 0-3.0 ] and combination group （56 cases received aspirin 100 mg QD, and dipyridamole 100 mg TID）. Patients without the following risk factors were defined as low cardiovascular risk, history of stroke or myocardial infarction history, age 〉 75, LVEF 〈 40% , diabetes. The incidence of death for any cause, thromboembolism （including stroke and peripheral arterial embolism ） and hemorrhage events were recorded. Results All patients were followed up for 12 to 28 months. In warfarin group, 3 cases were lost to follow up, one patient had ischemic stroke, one patient suffered from severe bleeding event, 3 cases had minor bleeding events. In combination treatment group, 2 cases were lost to follow up, 2 cases had ischemic stroke, one patient suffered from peripheral arterial embolism, 2 cases had minor bleeding events. No statistical difference was found in ischemie events [ 1.5 % （ 1/66 ） vs. 5.6% （ 3/54 ）, P = 0. 220 ] or bleeding events [ 6. 1% （ 4/66 ） vs. 3.7% （ 2/54 ）, P =0. 556 ] between the two groups. Conclusions Dose-adjusted warfarin is not better than aspirin/dipyridamole combination therapy for the prevention of thromboembolism events in NVAF patients with low cardiovascular risk.

关 键 词：心房颤动 血栓栓塞 华法林 阿司匹林 

分 类 号：R541.75[医药卫生—心血管疾病]