华法令、阿斯匹林预防心房颤动患者缺血性脑卒中的远期随访

Long-term follow-up of warfarin and aspirin preventing ischemic stroke in atrial fibrillation

目的了解并比较华法令、阿斯匹林预防心房颤动患者缺血性脑卒中的远期效果。方法分别对三组82例、106例、127例心房颤动患者口服华法令、阿斯匹林及对照组治疗进行临床、大便隐血、国际正常比(INR)、头颅CT或MR扫描并定期随访,随访时间分别为(50±2.8)月(、40±2.0)月和(43±3.2)月。结果缺血性脑卒中和短暂性缺血发作(TIA)的发生率华发令组(10.9%),明显较阿斯匹林组(18.10%)、对照组(25.40%)低(P<0.05,P<0.01),阿斯匹林组显著比对照组低(P<0.05)。出血发生率华法令组、阿斯匹林组及对照组分别为3.66%、2.86%、2.38%(P>0.05),死亡率分别为6.10%、6.67%、10.32%(P>0.05),均无显著性差异。缺血性脑卒中引起的死亡率分别为1.22%、1.90%、4.76%,对照组显著高于其他两组(P<0.05)。结论华法令、阿斯匹林预防心房颤动患者缺血性脑卒中的发生均有效,华法令优于阿斯匹林。华法令、阿斯匹林降低其缺血性脑卒中引起的死亡率。

Objective To study and compare the long-term results of warfarin , aspirin preventing ischemic stroke in atrial fibrillation. Methods A long-term follow-up survey was carried out in 82 cases of warfarin treating, 106 cases of aspirin treating and 127 cases without warfarin and aspirin treating（ control group） by clinical examination, fecal hemoglobin examination, International Nomalized Ratio （ INR ） and computed tomography or magnetic resonance brain scanning, The mean follow-up time was 50 ± 2.8,40± 2.0 and 43 ± 3.2 months respectively. Results The prevalence of ischemic stroke and transient ischemic attack （TIA） in warfarin group （10.9%） was significantly lower than in the aspirin group （18. 10 % ） and in the control group （25.40 % ） （ P〈0.05, P 〈 0.01 respectively）. Aspirin group was significantly lower com- pared with those control group （P 〈 0.05） ;Haemorrhagic complication occurred in warfarin group, aspirin group and control group were 3.66% ,2.86% ,2.38% respectively ,no differences was found in three groups （P〉0.05）; Death rate was 6.10 %, 6.67 % and 10.32 %, it was similar in three group （ P 〉 0.05 ）. There were 6 cases （ 4.76 % ） death due to ischemic stroke in the control group, but 1 case （ 1.22 % ） and 2 cases （ 1.90 % ） in warfarin group and aspirin group （ P 0.05 ）. Conclusion Warfarin and aspirin are efficient on preventing ischemic stroke in atrial fibrillation , but warfarin is apparently superior to aspirin. The death rates due to ischemic stroke were decreased significantly by warfarin or aspirin.