老年急性肺栓塞患者华法林抗凝治疗最佳起始剂量探究  

Optimal initial warfarin dose in anticoagulant therapy for elderly acute pulmonary thromboembolism patients

作　　者：王兵[1,2] 邝土光[1] 龚娟妮[1] 李积凤[1] 杨媛华[1] 

机构地区：[1]首都医科大学附属北京朝阳医院呼吸与危重症医学科北京呼吸疾病研究所,100020 [2]新疆医科大学附属中医医院呼吸科

出　　处：《中华老年心脑血管病杂志》2016年第12期1235-1238,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家"十二五"科技支撑计划(2011BAI11B17)

摘　　要：目的探讨老年急性肺栓塞患者华法林抗凝治疗最佳起始剂量临床应用价值。方法入选住我院确诊为急性肺栓塞的老年患者181例，分为2组，老年组（60～79岁）151例，高龄组（≥80岁）30例，给予华法林抗凝治疗后，观察2组华法林起始剂量、达标剂量、达标时间及出血发生情况；另将老年组根据初始服用华法林剂量又分为3个亚组，2．5mg组（31例）、3．75mg组（89例）和5．0mg组（31例），以确定华法林的最佳起始剂量。结果老年组患者华法林起始剂量和达标剂量均高于高龄组[（3．75士0．80）mg vs（3．18±0．83）mg，（4．97±1．59）mg725（3．96土1．11）mg，P〈0．01]；2组达标时间比较无显著差异（P〉0．05）。老年组3个亚组之间比较，随着起始剂量增加，达标剂量也增加（P〈0．05）。与2．5mg组和3．75mg组比较，5．0mg组达标剂量显著增高（P〈0．05），与2．5mg组比较，3．75mg组和5．0mg组达标时间显著降低（P〈0．05）。老年组3个亚组出血10例（6．6％），高龄组出血4例（13．3％）。结论老年急性肺栓塞患者，华法林抗凝治疗推荐起始剂量应该高于高龄患者，并注意密切监测。Objective To study the optimal initial warfarin dose in anticoagulant therapy for elderly acute PTE patients. Methods 181 acute PTE patients aged ≥60 years admitted to our hospital were divided into 60--79 years old group （n=151） and ≥80 years old group （n=30）. The patients received warfarin anticoagulant therapy and its initial dose,its target dose,time from initial dose to target dose and bleeding events were recorded. The patients in 60--79 years old group were further divided into 2.5 mg warfarin group （n=31）,3.75 mg warfarin group （n=89）,and 5.0 mg warfarin group （n=31） and the best initial warfarin dose was recorded. Results The initial and target warfarin doses were higher in 60--79 years old group than in ~80 years old group （3.75±0.80 mg vs 3.18±0.83 mg,4.97±1.59 mg vs 3.96±1.11 mg,P〈0.01）. No significant difference was found in time from initial to target warfarin dose between the two groups. The tar- get warfarin dose increased with the increasing initial warfarin dose in 2.5 mg warfarin group, 3.75 mg warfarin group,and 5.0 mg warfarin group （P〈0.05）. The target warfarin dose was significantly higher in 5.0 mg warfarin group than in 2.5 mg warfarin group and 3.75 mg warfa- rin group （P〈0.05） and was significantly lower in 3.75 mg warfarin group and 5.0 mg warfarin group than in 2.5 mg warfarin group （P〈0.05）. The incidence of bleeding was lower in 60-79 years old group than in ≥80 years old group （6.6% vs 13.3%）. Conclusion The recommended initial warfarin dose in anticoagulant therapy is higher for ≥80 years old acute PTE patients.

关 键 词：肺栓塞 华法林 抗凝药 药物剂量计算 

分 类 号：R563.5[医药卫生—呼吸系统]