非瓣膜性心房颤动并发缺血性脑卒中的防治

The prevention and treatment of nonvalvular atrial fibrillation associated with ischemic stroke

目的 探讨华法林和阿司匹林预防非瓣膜性心房颤动 (房颤 )并发缺血性脑卒中的有效性和安全性。方法 14 0例持续性房颤患者分为高危组和低危组 :高危组患者 10 0例 ,其中 5 4例接受口服华法林治疗 (INR目标值 1 6～ 2 5 ) ,4 6例口服肠溶阿司匹林 (10 0mg d)治疗 ;低危组 4 0例口服肠溶阿司匹林(10 0mg d)治疗。结果 高危组华法林的维持剂量 (2 6 8± 1 0 5 )mg ,INR值 1 82～ 2 4 9,随访期间无缺血性脑卒中事件发生 ,3例发生出血并发症 (INR 2 8～ 3 2 ) ;高危组阿司匹林治疗的 1例患者发生缺血性脑卒中 ;低危组患者无 1例发生缺血性脑卒中。结论 低强度华发林抗凝治疗可有效预防非瓣膜性房颤高危患者缺血性脑卒中的发生 ,并减少出血并发症 ;阿司匹林 (10 0mg d)可有效预防低危患者缺血性脑卒中事件的发生。

Objective To evaluate the safety and efficacy of warfarin and asprin on prevention and treatment of ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF ) . Methods One hundred and forty consecutive patients with persistent NVAF were divided into high risk group (high risk for ischemic stroke,n=100) and low risk group (n=40) based on echocardiography. Fifty-four patients in high risk group were treated with oral warfarin with the aim of keeping the international normalized ratio (INR) values between 1.6 and 2.5. Forty-six patients in high risk group and patients in low risk group were treated with oral aspirin (100 mg/d). Results There was no ischemic stroke in patients treated with warfarin and in low risk patients during follow-up. Bleeding occurred in patients who received oral warfarin (INR 2.8～3.2).High risk patients treated with aspirin had ischemic stroke. Conclusion Low intensity anticoagulation therapy with warfarin may prevent ischemic stroke effectively in high risk patients with NVAF, and reduce bleeding.Low risk patients may receive 100 mg/d aspirin.