不同强度华法林抗凝治疗对冠心病合并非瓣膜性心房颤动患者的效果及安全性  

Efficacy and Safety of Different Intensity of Warfarin Anticoagulant Therapy on Patients with Coronary Heart Disease Complicated with Nonvalvular Atrial Fibrillation

作　　者：陈菲菲 王琛惠 聂富意 刘秀梅[3] CHEN Feifei;WANG Chenhui;NIE Fuyi;LIU Xiumei(Department of Clinical Pharmacy,Henan Electric Power Hospital,Zhengzhou 450000,China;the Second Ward of Internal Medicine,Henan Electric Power Hospital,Zhengzhou 450000,China;Department of Clinical Pharmacy,Zhengzhou People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]河南电力医院临床药学室,河南郑州450000 [2]河南电力医院内二科,河南郑州450000 [3]郑州人民医院临床药学科,河南郑州450000

出　　处：《河南医学研究》2022年第23期4250-4253,共4页Henan Medical Research

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20191090)。

摘　　要：目的探讨不同华法林抗凝治疗强度对冠心病合并非瓣膜性心房颤动患者的效果及安全性。方法选择2020年1月至2021年12月在河南电力医院就诊的71例冠心病合并非瓣膜性心房颤动患者作为研究对象,按随机数字表法将其分为低治疗强度组(36例)和常规治疗强度组(35例)。两组患者在入院后均接受华法林钠片口服治疗,低治疗强度组患者控制国际标准化比值(INR)在1.5~2.1,常规治疗强度组患者控制INR在2.2~3.0。随访6个月,对两组患者主要疗效终点事件、出血事件进行评价,并记录INR稳定时华法林的使用剂量。结果两组患者在治疗3、6个月时,缺血性脑卒中、腔隙性脑梗死和体循环栓塞等主要临床终点事件的发生率差异无统计学意义(P>0.05);随访6个月,低治疗强度组出血事件发生率(5例,13.89%)低于常规治疗强度组(12例,34.29%),差异有统计学意义(P<0.05);INR指标稳定时,低治疗强度组患者每日华法林使用剂量[(2.45±0.60)mg]低于常规治疗强度组[(3.18±0.70)mg],差异有统计学意义(P<0.05)。结论对于冠心病合并非瓣膜性心房颤动患者,华法林低治疗强度(INR 1.5~2.1)和常规治疗强度(INR 2.2~3.0)在预防缺血性脑卒中、腔隙性脑梗死和体循环栓塞的发生方面疗效相似,但低治疗强度可明显减少华法林日口服剂量,降低各种出血事件的发生风险。Objective To investigate the effects of different intensity of warfarin anticoagulant therapy on the efficacy and safety of patients with coronary heart disease complicated with nonvalvular atrial fibrillation.Methods A total of 71 patients with coronary heart disease complicated with non-valvular atrial fibrillation treated in Henan Electric Power Hospital from January 2020 to December 2021 were selected as the research subjects,and they were divided into the low intensity group(36 cases)and the conventional intensity group(35 cases)by random number table method.The patients in both groups were given oral warfarin sodium tablets after admission.The international standardized ratio(INR)of patients in the low treatment intensity group was in the range of 1.5 to 2.1,and INR of patients in the conventional treatment intensity group was in the range of 2.2 to 3.0.After 6 months of follow-up,the main efficacy end points and bleeding events in both groups were evaluated,and the dosage of warfarin was recorded when INR was stable.Results There were no significant differences in the incidence of major clinical endpoint events of ischemic stroke,lacunar cerebral infarction,and systemic circulation embolism between the two groups at 3 and 6 months of treatment(P>0.05).During 6 months follow-up,the incidence of bleeding events in the low intensity group(5 cases,13.89%)was lower than that in the conventional intensity group(12 cases,34.29%),and the difference was statistically significant(P<0.05).When INR was stable,the daily dose of warfarin in the low treatment intensity group[(2.45±0.60)mg]was lower than that in the conventional intensity group[(3.18±0.70)mg],and the difference was statistically significant(P<0.05).Conclusion For coronary heart complicated with nonvalvular atrial fibrillation,warfarin treatment of low intensity(INR 1.5-2.1)and conventional intensity(INR 2.2-3.0)were similar in the prevention of ischemic stroke,lacunar cerebral infarction and systemic circulation embolism,but low treatment intensity coul

关 键 词：冠心病 非瓣膜性心房颤动 华法林 抗凝强度 栓塞 安全性 

分 类 号：R541.7[医药卫生—心血管疾病]