华法林治疗80岁及以上老年心房颤动患者临床观察  

Clinical observation of warfarin in the treatment of 80 years and older patients with atrial fibrillation

作　　者：袁棋炎 谢金丹[1] 石理[1] 

机构地区：[1]暨南大学附属珠海医院.珠海市人民医院心内科,广东珠海市519000

出　　处：《内科》2016年第6期842-844,875,共4页Internal Medicine

摘　　要：目的探讨80岁及以上老年心房颤动患者接受低强度和标准强度华法林抗凝治疗的安全性及疗效;评估采用HAS-BLED出血风险评分系统指导老年人抗凝治疗的可行性。方法选取2012年1月至2014年1月在我院门诊随诊的80岁及以上的心房颤动患者120例作为研究对象,随机分为标准强度抗凝组和低强度抗凝组,每组60例,分别接受标准强度和低强度的华法林抗凝治疗。随访1年,比较两组患者主要出血事件及缺血性脑卒中的发生率;利用HAS-BLED出血风险评分系统对两组患者进行评分。结果两组患者缺血性脑卒中发生率比较差异无统计学意义(P>0.05);标准强度抗凝组患者出血发生率显著高于低强度抗凝组(P<0.05)。120例患者中,HAS-BLED评分为2分或以上的患者严重出血发生率为2.5%,评分为1分的患者无严重出血事件发生。结论 80岁及以上心房颤动患者接受低强度华法林抗凝治疗的效果与标准强度华法林抗凝治疗相当,但低强度华法林抗凝治疗可以显著降低患者出血风险。HAS-BLED出血评分可用来评估老年人抗凝治疗的出血风险,通过纠正及监测可改变的出血危险因素,可减少抗凝治疗出血事件的发生。Objective To explore the safety and efficacy of warfarin in the treatment of 80 years and older patients with atrial fibrillation, assess the feasibility of the HAS-BLED bleeding-risk-score system in guiding anticoagulation therapy in elderly patients. Methods A total of 120 outpatient follow-up patients with atrial fibrillation in our hospital from January 2012 to January 2013 were enrolled and randomly divided into standard-intensity group and low-intensity group, with 60 cases in each group, and all patients were 80 years old or older. The standard-intensity group received warfarin for standard-intensity, while the low-intensity group received warfarin for low-intensity. After follow-up for one year, the incidences of major bleeding events and ischemic stroke were compared between two groups, and the HAS-BLED bleeding-risk-score system was used to evaluate the risk of hemorrhage. Results That was no significant difference of incidence of ischemic stroke was found between the two groups （ P 〉 0.05 ） ; the incidence of bleeding events in the standard-intensity group was significantly higher than that in the low-intensity group （P 〈 0.05）. Among 120 cases of patients, the incidence rate of serious bleeding was 2.5% in patients who the score of HAS-BLED was 2 points or more, and no serious bleeding event was found in patients who the score of HAS-BLED was 1 points. Conclusions Low-intensity and standard-intensity therapy with warfarin has the same effect in the treatment of 80 years and older patients with atrial fibrillation, but low-intensity can reduce the risk of hemorrhage. HAS-BLED bleeding-risk-score system can used to evaluate the risk of hemorrhage in elderly patients who receive anticoagulant therapy, correct and monitor the reversible bleeding-risk-factors can reduce the occurrence of bleeding events during anticoagulation therapy.

关 键 词：心房颤动 老年人 华法林 HAS-BLED 脑卒中 

分 类 号：R541.75[医药卫生—心血管疾病]