老年心房颤动患者华法林长期抗凝治疗的效果与安全性  

Efficacy and safety of long-term anticoagulation therapy with warfarin in elderly patients with atrial fibrillation

作　　者：徐荣[1] 郭金成[1] 郭明[1] 

机构地区：[1]首都医科大学潞河教学医院心内科,北京101149

出　　处：《临床荟萃》2015年第3期272-275,共4页Clinical Focus

摘　　要：目的探讨老年心房颤动(房颤)患者华法林长期抗凝治疗的疗效、安全性和华法林剂量的动态变化,为经验性抗凝治疗提供依据。方法选取心血管专科门诊每月进行规律随访的抗凝治疗时间>12个月、年龄≥65岁的持续性房颤患者52例,根据随访记录统计患者出血、脑梗死的情况以及华法林的用药剂量。结果经心电图确诊的持续性房颤患者52例,其中男30例,女22例,平均年龄(72.5±5.6)岁,平均随访时间(23.20±11.35)个月;在随访期间,未出现颅内出血等严重威胁生命的出血,轻度出血10例,其中牙龈出血2例、鼻出血1例、咯血2例、结膜出血3例和双下肢皮肤瘀斑2例;52例患者出现脑梗死1例(1.9%);在长达24个月的随访时间中,房颤患者华法林抗凝治疗的剂量无显著变化,达到充分抗凝的平均剂量为3.6mg/d左右。结论房颤患者长期抗凝治疗安全有效,其平均维持剂量约为3.6mg/d,但需要规律检测国际标准化比值。Objective To evaluate the efficacy and safety of long-term anticoagulation therapy with warfarin in elderly patients with atrial fibrillation and the sustaining dosage of warfarin, and to provide empirical dose of warfarin during the course of long-term anticoagulation. Methods Fifty-two elderly patients with atrial fibrillation whose anticoagulation duration exceeded 12 months were included into this study, all the patients suffered from atrial fibrillation for more than 12 months, and the hemorrhage event, stroke event and the sustaining dosage of warfarin in each patient were determined by the follow-up record. Results Thirty male patients and twenty-two female patients averaged age （72.45 ± 5.56） years old were diagnosed as permanent atrial fibrillation by electrocardiography, the average duration of follow-up was （23.20±11.35） months. No fatal hemorrhage event such as cerebral hemorrhage was found during the course of long-term anticoagulation, mild hemorrhage was found in 10 patients, including 2 patients with gingiva hemorrhage, 1 patient with epistaxis, 2 patients with hemoptysis, 2 patients with ecchymosis in the left leg and the other 3 patients with conjunctiva hemorrhage. After adjusting the dosage of warfarin, all the hemorrhage symptom disappeared. Stroke event emerged in 1 patient and the incidence was 1.9%. No change was found in the sustaining dosage of warfarin during the course of long-term anticoagulation and the average dosage of warfarin was about 3.6 mg/d when giving sufficient anticoagulation therapy. Conclusion Long-term anticoagulation therapy with warfarin in the elderly patients with AF is safe and efficacious and the sustaining dosage of warfarin is about 3.6 mg/d .

关 键 词：心房颤动 抗凝治疗 心电描记术 

分 类 号：R541.75[医药卫生—心血管疾病]