高龄高出血风险心房颤动患者的超低强度华法林抗凝治疗分析  

Ultra-low intensity warfarin anticoagulation in octogenarians with nonvalvular atrial fibrillation and high risk of hemorrhage

作　　者：马彩艳[1] 谢培怡[1] 张伟[1] 应永军[1] 张田杰[1] 陈旭峰[1] 

机构地区：[1]浙江省立同德医院心内科,310012

出　　处：《心电与循环》2015年第1期25-27,共3页Journal of Electrocardiology and Circulation

摘　　要：目的观察老年非瓣膜性心房颤动患者超低强度华法林的抗栓疗效和安全性。方法37例年龄≥80岁、HAS- BLED出血风险积分≥3分的老年非瓣膜性心房颤动患者行华法林治疗。控制国际标准化比值在1.4-1.9（超低强度组）和2.0-2.5（低强度组）。随访12个月，观察缺血性脑卒中发生率和出血性合并症。结果超低强度和低强度组脑卒中CHA2DS2- VASc危险评分分别为（3.50±0.89）、（3.40±0.97）分，差异无统计学意义（P＞0.05）；HAS- BLED出血评分分别为（4.70±0.98）、（5.10±0.93）分，差异无统计学意义（P＞0.05）。超低强度和低强度组脑卒中发生率分别为5.0%、5.8%（P＞0.05）；严重出血发生率分别为0、5.9%，轻微出血发生率分别为10.0%、23.6%（P＜0.05）。结论对于高龄非瓣膜性心房颤动患者，华法林超低强度与低强度抗凝预防脑卒中疗效相近，但出血并发症少。Objective To investigate the effect and safety of warfarin anticoagulation in ultra- low intensity in octogenarians with nonvalvular atrial fibril ation （NVAF）. Methods 37 NVAF patients aged ≥80 years old and with HAS- BLED score≥3 were treated with warfarin. International normalized ratio was control ed to a range of 1.4 to 1.9 in ultra- low intensity group （ULI group） and 2.0 to 2.5 in low intensity group （LI group）. Al patients were fol owed up for 12 months.The ischemic stroke and bleeding events were assessed. Results CHA2DS2- VASc and HAS- BLED scores were similar between ULI and LI group[（3.50±0.89）vs.（3.40±0.97）, （4.70±0.98）vs.（5.10±0.93）,respectively] . The incidence of ischemic stroke was similar in ULI and LI group （5.0% vs. 5.8%, P 〉0.05）, while the severe and mild bleeding was significantly more frequent in LI group （5.9%and 23.6% ）than ULI group （ 0 and 10%）（P〈0.05）. Conclusion Warfarin anticoagulation in ultra- low intensity has similar effect as that in low intensity on prevention of stroke in octogenarians with NVAF, but with lower bleeding risk.

关 键 词：出血风险 非瓣膜性心房颤动 华法林 老年人 

分 类 号：R541.75[医药卫生—心血管疾病]