超高龄心房颤动患者华法林抗凝过程中心血管不良事件的观察  

Warfarin anticoagulation in elderly patients with atrial fibrillation : evaluation by occurrence of adverse cardiovascular events

作　　者：黄红漫[1] 查爽英[1] 刘新兵[1] 柏晓松[2] 冯六六[1] 

机构地区：[1]上海市杨浦区市东医院心内科,上海200438 [2]上海市杨浦区市东医院检验科,上海200438

出　　处：《诊断学理论与实践》2016年第5期513-516,共4页Journal of Diagnostics Concepts & Practice

基　　金：上海市卫生和计划委员会立项课题组(20134374)

摘　　要：目的：观察超高龄房颤患者采用不同强度华法林抗凝后的心血管不良事件发生情况,探讨此类患者国际标准化比值（international normalized ratio,INR）的合理范围,为临床提供依据。方法：将108例超高龄房颤患者（年龄≥80岁）按INR值分为中等强度抗凝组（56例）和低等强度抗凝组（52例）;低等强度抗凝组的INR维持在1.40-1.80;中等强度抗凝组的INR维持在1.81-2.50。随访（1.8±1.2）年,观察发生主要终点事件（缺血性卒中、全身性栓塞）、次要终点事件（非致命性心肌梗死、全因死亡联合终点）、安全性终点事件（致命性出血、严重出血和轻度出血）的情况。结果：随访期间,中等强度抗凝组中有3例患者发生栓塞,发生率为5.36%;低等强度抗凝组中有6例发生栓塞,发生率为11.54%,均为脑卒中,2组间差异有统计学意义（P〈0.05）。低等强度抗凝组中2例、中等强度抗凝组中3例患者出现眼结膜、鼻出血等不良反应,但均无严重出血,2组间出血发生率差异无统计学意义（P〉0.05）。结论：超高龄房颤患者应用华法林,INR维持在1.81-2.50是安全、有效的。Objective： To investigate the occurrence of adverse cardiovascular events in elderly patients with atrial fibrillation（AF） during anticoagulation with warfarin. Methods： One hundred and eight older patients（80 years or older）taking warfarin for AF were enrolled. According to the value of international normalized ratio（INR）, patients were divided into 2 groups, low intensity warfarin group（INR between 1.40 and 1.80, n=52） and moderate intensity warfarin group（INR between 1.81 and 2.50, n=56）, and effects and safety were compared. All patients were followed up for（1.8 ±1.2） years.The major end point events included the occurrence of ischemic stroke or systemic embolism;the secondary endpoint events included non-fatal myocardial infarction and all causes of death. The safety endpoint events included the occurrence of the mild, severe and fatal hemorrhage. Results： Embolism occurred in 3 patients（5.36%） in moderate intensity warfarin group and in 6 patients（11.54%） in low intensity warfarin group（all were cerebral stroke）; the difference was statistically significant. Conjunctival and nasal hemorrhage occurred in 2 patients in low intensity warfarin group and in 3 patients in moderate intensity warfarin group; no severe hemorrhage was seen in all the patients. No significant difference in hemorrhagic rate was seen between the low intensity and moderate intensity warfarin groups（P〉0.05）. Conclusions： The INR ranged from 1.81-2.50 is safe for elderly patients with atrial fibrillation treated with warfarin for anticoagulation.

关 键 词：心房颤动 华法林 老年 安全性 

分 类 号：R541.75[医药卫生—心血管疾病]