华法令预防心房纤颤患者并发脑梗死的疗效观察

Warfarin on prevention of brain infarction:A randomized observation on patients with atrium fibrillation

目的观察华法令与阿司匹林联用与单用阿司匹林在预防心房纤颤（AF）患者并发脑梗死的疗效差距,探讨心房纤颤患者长期服用华法令的有效性、安全性与可行性。方法80例心房纤颤患者随机分为华法令组40例与阿司匹林组40例,2组均予拜阿司匹灵100mg/d早餐后顿服,华法令组加用华法令晚饭后口服,起始剂量为2mg/d,1周后若INR（凝血酶原国际标准化比值）未达到2.0~3.0,逐步增加华法令剂量使INR值在2.0~3.0之间。随访3年,比较2组患者脑梗死的发生率、病死率、总病死率（包括脑梗死及非脑梗死事件）、出血事件发生率、严重出血发生率、轻度出血发生率。结果华法令组和阿司匹林组脑梗死发生分别为2例（5.0%）和6例（15.0%）,2组比较,P〈0.01;华法令组和阿司匹林组脑梗死患者死亡分别为0例（0%）和2例（5.0%）,2组比较,P〈0.01;总死亡华法令组和阿司匹林组分别为2例（5.0%）和4例（10.0%）,P〈0.01;2组发生严重出血均为0例,P〉0.05;华法令组轻度出血发生6例（15.0%）,其中皮下出血4例,阿司匹林组发生1例（2.5%）,华法令组高于阿司匹林组,P〈0.01,但给予调整剂量后症状消失,不影响继续用药。结论AF患者在常规使用阿司匹林的基础上加用抗凝药物华法令长期口服,可使脑梗死的发生率、脑梗死患者病死率、总病死率明显降低,在合理监测的情况下并未发生严重出血。建议在能定期监测INR值的AF患者中推广使用,以使更多AF患者受益。

Objective To observe the differences of therapeutic effects between single application of aspirin and combined application of warfarin and aspirin on prevention of complicated brain infarction in patients with atrium fibrillation（AF）, for investigating the efficacy, safety and feasibility of long-term application of warfarin on these patients.Methods 80 patients with atrium fibrillation were equally randomized into warfarin group （n=40） and aspirin group（n=40）. Both groups were given 100 mg/d bayer aspirin after breakfast, and oral warfarin were added after supper in warfarin group with an initial dosage of 2 mg/d, which gradually increased until international normalised ratios（INR） reached 2.0～3.0. Comparisons of incidence and mortality of cerebral infarction, total mortality （including cerebral infarction and non-brain infarction events） as well as occurance rate of hemorrhage events, severe hemorrhage events and mild hemorrhage events were made between the two groups. Results 2 patients （5.0%） in warfarin group and 6 （15.0%） in aspirin group occurred cerebral infarction, comparison between them demonstrated a significant difference, P〈0.01. There were no deaths in warfarin group whereas 2 in aspirin group, with a value of P〈0.01 indicating obvious difference. For total mortality, there were 2 （5.0%） in warfarin group and 4 （10.0%） in aspirin group, P〈0.01. No occurance of severe hemorrhage was discovered, P〉0.05. 6 patients （15.0%） were detected mild hemorrhage, 4 of which were subcutaneous hemorrhage, and 1 in aspirin group （2.5%）; when compared the two, incidence was greater in warfarin group than that in aspirin group , P〈0.05, however, warfarin was continued of using after hemorrhage halted via adjusting the dosage. Conclusion Application of long-term oral warfarin on the basis of aspirin on patients with atrium fibrillation reduces the incidence and mortality of cerebral infarction, as well as total mortality obviously, without occurance of severe hemorrhage with INR monitored. So, such combinative application is beneficial for patients with atrium fibrillation who undergo INR monitoring periodically, and thus worthy of popularization.