华法林预防老年非瓣膜性心房颤动患者缺血性脑卒中及出血风险的临床对照研究  

Ischemic stroke and bleeding risk in elderly patients with non-valvular atrial fibrillation treated with warfarin

作　　者：何水波[1] 郁水华[1] 孟锐[1] 茹松伟[1] 龚祚娟[1] 刘慧敏[1] 张然[1] 

机构地区：[1]航天中心医院高干一科,北京100039

出　　处：《中国心血管杂志》2013年第4期268-271,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨华法林不同抗凝强度预防老年非瓣膜性心房颤动患者缺血性脑卒中的效果及出血风险。方法 177例年龄大于65岁,美国卒中风险评分≥2分(CHADS2≥2)患者按出血风险评分分为高危组(HAS-BLED≥3分)103例,低危组(HAS-BLED<3分)74例。高危组给予低等强度抗凝,国际标准化比值(INR)控制在1.5～2.5,低危组给予中等强度抗凝,INR控制在2.0～3.0。观察记录两组患者服药期间出血及缺血性脑卒中风险有无差异。结果 177例患者中位随访时间为16.9(6.3～30.9)个月,随访期间高危组发生轻微出血事件8例,发生率为5.5/100患者年,低危组为5例,发生率为4.7/100患者年;随访期间两组患者轻微出血风险差异无统计学意义(HR:1.88,P=0.15),未发生严重出血事件。高危组发生缺血性脑卒中2例,发生率为1.4/100患者年,低危组发生缺血性脑卒中1例,发生率为0.9/100患者年,两组缺血性脑卒中发生风险差异无统计学意义(HR:0.89,P=0.94)。结论根据出血风险评分制定华法林抗凝强度可有效降低患者的出血风险,同时又不降低华法林预防缺血性脑卒中的效果。Objective To evaluate the ischemic stroke and bleeding risk in elderly patients with non-valvular atrial fibrillation treated by warfarin with different intensity. Methods One hundred and seventy seven non-valvular atrial fibrillation patients, older than 65 years old, were divided into high bleeding risk group （ HAS-BLED ≥ 3, n = 103 ） or low bleeding risk group （ HAS-BLED 〈 3, n = 74 ）. Patients in high-risk group were treated with low intensity of anticoagulation, with international normalized ratio （INR） between 1.5 and 2. 5. And the low-risk group were given moderate-intensity anticoagulation with INR 2. 0-3. 0. The major/minor bleeding and ischemic stroke risk between the two groups were recorded and compared. Results The median follow-up time of the 177 patients was 16. 9 （6. 3-30. 9 ） months8 cases of minor bleeding events occurred during follow-up in high-risk group, with the incidence rate of 5.5 per 100 person years. 5 cases occurred in low-risk group, with the incidence rate of 4. 7 per 100 person years. No statistical difference of minor bleeding risk was observed between the two groups （ HR ： 1.88, P = 0. 15）. No severe bleeding events during follow-up period. 1 ischemic stroke was observed in high-risk group （ 1.4% ） and 1 in low-risk group （ 0. 9% ） and there was no statistical difference of ischemic stroke between the two groups （ HR ： 0. 89, P = 0.94）. Conclusions The risk of ischemic stroke and bleeding in patients with non-valvular atrial fibrillation treated by warfarin can be significantly reduced by different anticoagulation intensity according to HAS-BLED score.

关 键 词：华法林 心房颤动 出血 缺血性脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]