华法林预防非瓣膜性心房颤动老年患者脑栓塞

Warfarin in prevention of cerebral thromboembolism in elderly patients with nonvalvular atrial fibrillation

目的观察不同抗凝强度华法林预防非瓣膜病心房颤动(简称房颤)老年患者脑栓塞的效果及出血不良事件。方法264例非瓣膜病房颤老年患者随机分为两组,分别给予华法林抗凝强度国际标准化比值(INR)1.7～2.2(低强度组,152例)和INR2.3～3.0(中强度组,112例)抗凝治疗。观察两组脑栓塞并发症及出血事件发生率。结果低强度组患者脑栓塞年发生率为2.2%,与中强度组患者的1.9%比较差异无统计学意义(χ2=0.115,P>0.05)。低强度组患者的严重出血事件年发生率为0.7%,与中强度组患者的1.0%比较差异无统计学意义(χ2=0.254,P>0.05),但低强度组患者轻微出血事件年发生率3.6%明显低于中强度组患者10.7%(χ2=4.086,P<0.05)。结论华法林抗凝强度INR1.7～2.2能明显降低老年非瓣膜病房颤脑栓塞发生率,INR2.3～3.0时轻微出血事件增加。

Objective To observe the anticoagulate effect and side effect of warfarin in prevention of cerebral thromboembolism in elderly patients with nonvalvular atrial fibrillation. Methods Two hundred and sixty four patients with atrial fibrillation were randomly divided into two groups and all took different target international normalize ratio （INR） of Warfarin. In the first group （152 patients） the INR was 1.7-2.2 （low intensity） and in the second group （112 patients） the INR was 2.3-3.0 （moderate intensity）. The incidence of cerebral thromboembolism and hemorrhage were compared. Results Two hundred and forty two patients finally finished the observation, including 139 patientsin low intensity group and 103 in moderate intensity group. The yearly incidence of cerebral thromboembolism was 2.2% and 1.9% in low intensity and moderate group, respectively （P〉0,05）. The incidence of severe bleedingin in low intensity group was not significant different with that in moderate intensity group （0.7% vs 1.0%, P〉0.05）. The incidence of mild hemorrhagein the moderate intensity group was higher than that in low intensity group（1.07% vs 3.6%, P〈0.05 ）. Conclusions To maintain the INR at 1.7-2.2 with warfarin could safely reduce the incidence of cerebral thromboembolism in elderly patients with nonvalvular atrial fibrillation.