华法林对老年非瓣膜性心房颤动患者抗栓的有效性和安全性  

Efficacy and safety of antithrombotic therapy with warfarin in elderly patients with nonrheumatic atrial fibrillation

作　　者：仝峰[1] 慕春言[1] 王景斌[1] 苏毅[1] 杨琴[1] 

机构地区：[1]河南省焦作市第二人民医院心内科,454001

出　　处：《中国实用医刊》2011年第3期48-49,52,共3页Chinese Journal of Practical Medicine

摘　　要：目的观察阿司匹林与不同抗凝强度的华法林预防75岁以上老年非瓣膜性心房颤动（房颤）患者发生血栓栓塞的有效性和安全性。方法将75岁以上老年非瓣膜性房颤108例分为肠溶阿司匹林组（150mg/d，36例）、华法林抗凝强度国际标准化比率（INR）1．8～2．4（低等强度组，37例）和INR2．5～3．0（中等强度组，35例）三组。观察三组血栓栓塞并发症及出血等不良反应的发生率。结果三组患者基线特征（包括合并疾病和伴随用药）差异无统计学意义。阿司匹林组、华法林低等强度组、华法林中等强度组血栓栓塞事件发生率分别为16．6％、8．1％、5．7％，不同抗凝强度华法株组较阿司匹林组显著降低血栓栓塞事件（P〈0．05），而不同抗凝强度华法林组间比较差异无统计学意义（P〉0．05）。三组总出血不良反应的发生率分别为2．8％、5．4％、11．4％，三组间比较差异均有统计学意义（P〈0．05），但无严重致死性出血病例。结论华法林抗凝强度INR1．8～3．0能明显降低75岁以上老年非瓣膜性房颤患者血栓栓塞事件的发生率，INR1．8～2．4时出血发生率较低，安全性较好。Objective To observe the safety and prophylactic effect of different anticoagulate intensity of warfarin on the prevention of thrombo - embolism in patients over 75 - years old with nonrheumatic atrial fibrillation. Methods One hundred and eight patients over 75 - years old with nonvalvular atrial fibrillation were randomly divided into to receive aspirin 150 mg once daily or different doses of warfarin. The first group was asipilin group, the second group＇ s INR was 1.8 - 2. 4 （low intensity group,37 pa- tients）, the third group＇s INR was 2. 5 -3. 0 （middling intensity group,35 patients）. The incidence of the sideeffects such as thrombo- embolism and haemorrhagia were compared. Results The incidence of thrombo -embolism were 16. 6%, 8. 1% , 5.7% in asipilin group, low intensity group and middling intensity group. The incidence of thrombo - embolism in asipilin group was higher than that in two warfarin groups （ P 〈 0. 05）, there was no significant difference between the low intensity group and middling intensity group. The haemorrhagia events were 2.8% , 5.4% , 11.4% in asipilin group,low intensity group and middling intensity group. And a significant difference was found between every two groups （P 〈 0. 05）. No patient had serious bleeding in these three groups. Conclusions To maintain the INR at 1.8 - 3.0 with warfarin could reduce the incidence of thrombo - embolism remarkably in patients over 75 years old with nonvalvular atrial fibrillation. INR at 1.8 - 2. 4 is sate because of slightly decreased hemorrhage.

关 键 词：心房颤动 华法林 阿司匹林 国际标准化比 

分 类 号：R541.75[医药卫生—心血管疾病]