不同强度华法林抗凝治疗非瓣膜病性房颤患者疗效长期随访研究（英文）  

Long-term follow-up study of warfarin anticoagulant therapy effect of different intensity on patients with nonvalvular atrial fibrillation

作　　者：武云涛[1] 高迎春 田国祥[1] 夏常泉[1] 姚璐[1] 张薇[1] 朱润秀 

机构地区：[1]北京军区总医院干四科,北京100700 [2]内蒙古自治区人民医院心内科 [3]内蒙古自治区人民医院神经内科

出　　处：《心血管康复医学杂志》2016年第2期153-157,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：内蒙古自治区科技厅基金资助项目(20110501)

摘　　要：目的：分析不同强度华法林抗凝治疗老年非瓣膜病性房颤（NVAF）患者长期疗效及安全性。方法：随访5年的NVAF患者按年龄分为高龄老年组65例,年龄≥80（85.00±2.09）岁;老年组75例,年龄65-79（76.50±2.27）岁;中年组57例,年龄〈65（57.40±2.18）岁。入选患者长期服用华法林抗凝治疗,高龄老年组和老年组采用低强度抗凝,国际标准化比值（INR）：1.6-2.5;中年组INR为2-3,比较3组患者长期口服华法林5年的血栓事件及出血等不良反应,探讨华法林的安全用药范围。结果：随访5年,3组无1人出现急性脑梗死（P〉0.05）。高龄华法林组剂量（2.85±0.49）mg,INR（2.16±0.32）,CHA2DS2-VASc（2.33±0.48）分,老年华法林组剂量（2.95±0.38）mg,INR（2.20±0.28）CHA2DS2-VASc（2.64±0.77）分,两组差异无统计学意义（P〉0.05）。中年华法林组剂量（3.29±0.49）mg,INR（2.54±0.44）CHA2DS2-VASc（3.02±0.89）分,明显大于高龄组和老年组（P均〈0.01）。中年组,老年组和高龄老年组在轻微出血（21.1%比14.7%比24.6%）和严重出血发生率（1.8%比1.3%比1.5%）无显著差异（P〉0.05）。结论：对于老年NVAF患者应用华法林抗凝治疗,如能严密监测INR,INR控制在1.6-2.5是安全有效的。Objective：To analyze long-term therapeutic effect and safety of warfarin anticoagulant therapy of different intensity on aged patients with nonvalvular atrial fibrillation（NVAF）.Methods：According to age,a total of197 NVAF patients followed up for five years were divided into advanced aged group[n=65,≥80（85.00±2.09）years],aged group[n=75,65-79（76.50±2.27）years]and middle-aged group [n=57,〈65（57.40±2.18）years].All enrolled patients received long-term warfarin anticoagulant therapy,advanced aged group and aged group received low intensity anticoagulation,international normalized ratio（INR）was 1.6-2.5,while middle-aged group received standard intensity anticoagulation and the INR was 2.0-3.0.Thrombus events and incidence rates of hemorrhage etc.over five years were compared among three groups,and the safe dose range of warfarin was explored.Results：During five-year follow-up,no acute cerebral infarction occurred in three groups.The bleeding and other adverse reaction among three groups were no significant difference（P〉0.05）.Compared with middleaged group,there were significant reductions in warfarin dose[（3.29±0.49）mg/d vs.（2.95±0.38）mg/d,（2.85±0.49）mg/d],INR [（2.54±0.43）vs.（2.20±0.29）,（2.16±0.32）]and CHA2DS2-VASc [（3.02±0.89）scores vs.（2.64±0.77）scores vs.（2.33±0.48）scores]in aged group and advanced aged group,P〈0.01all;but there were no significant difference between aged group and advanced aged group（P〉0.05）.There were no significant difference in incidence rates of mild hemorrhage（21.1% vs.14.7% vs.24.6%）and severe hemorrhage（1.8% vs.1.3% vs.1.5%）among middle-aged group,aged group and advanced aged group,P〉0.05 all.Conclusion：When INR is closely monitored,INR controlled within 1.6-2.5warfarin anticoagulation is safe and effective for in aged patients with nonvalvular atrial fibrillation.

关 键 词：心房颤动 国际标准化比 安全 华法林 

分 类 号：R541.75[医药卫生—心血管疾病]