不同抗凝强度华法令预防非瓣膜病心房颤动患者血栓栓塞(附212例临床观察)

Clinical Observation of Different Anticoagulate Intensity of Warfarin in Prevention of Thrombo-embolism on 212 Patients with Nonrheumatic

目的 探讨不同抗凝强度华法令预防非瓣膜病心房颤动 (Af)患者血栓栓塞事件的效果及其不良反应。方法 2 12例非瓣膜病Af患者随机分为两组 ,分别给予华法令抗凝强度国际标准化比率 (INR) 1 80～2 . 4 0 (低等强度 ,12 3例 )和INR2. 4 1～ 3 .0 0 (中度强度 ,89例 )抗凝治疗。观察两组血栓栓塞并发症及出血等不良反应发生率。结果 低等强度抗凝组血栓栓塞年发生率为 0 . 6 6 % ,与中等强度抗凝组的 0 13%比较无显著差异 (P >0 . 0 5 )。低强度抗凝组的出血不良反应年发生率为 2 .4 % ,明显低于中等强度抗凝组的 7 9% (P <0 . 0 5 ) ,但两组均未见严重出血及其他严重不良反应。结论 华法令抗凝强度 1. 80～ 3. 0 0能明显降低非瓣膜病Af患者血栓栓塞发生率。INR 2 . 4 1～ 3 .0 0时自发出血危险性增加。

Objective To explore the prophylactic effect and side effect of different anticoagulate intensity of warfarin on the prevention of thrombo-embolism in patients with nonrheumatic atrial fibrillation. Methods 212 patients with atrial fibrillation were randomly divided into two groups and all took different anticoagulate intensity(INR) of warfarin. The first group's (123 patients) INR is 1.80-2.40(low intensity), the second group's (89 patients) INR is 2.41-3.00 (middle intensity). The incidence of side effect such as thrombo-embolism and hemorrhage was compared. Results The incidence of thrombo-embolism was 0.66% and 0.13% per annum in low intensity and middle group, respectively. There was no significant difference between two groups(P>0 05). The incidence of hemorrhage was 2.4% and 7.9% per year in low and middle intensity group, respectively. It was significant higher in middle intensity group than in low intensity group(P<0.05). No patient had serious bleeding and other side effects in both groups. Conclusions To maintain the INR at 1.80-3.00 with warfarin could safely reduce the incidence of thrombo-embolism significantly in patients with nonrheumatic atrial fibrillation. Warfarin INR at 2.41-3.00 has a higher danger of unexpected bleeding.