中国人心房颤动华法林抗凝治疗的目标INR范围究竟宜为多少?

What is the Optimal Intensity of Warfarin Therapy in Chinese Patients with Atrial Fibrillation

华法林抗凝治疗是目前预防缺血性脑卒中唯一有效的、不可取代的药物，也是心房颤动（房颤）治疗的基石。欧关指南建议多数75岁以下房颤患者血栓栓塞事件的一级预防和二级预防，国际标准化比值（INR）在2．5（2．0～3．0）；75岁以上出血高危患者血栓栓塞事件的一级预防，INR在2．0（1．6～2，5）。亚洲人华法林肝脏代谢酶活性与西方人存在较大差异，因此剂量应调低。国内初步研究显示：INR在1．6～2.5范围的华法林抗凝治疗是有效安全的，其预防非瓣膜性房颤患者发生血栓栓塞事件的作用优于阿司匹林，但尚需进一步的大规模临床试验以证实。

The warfarin anticoagulation treatment could decrease the stroke rate significantly in patients with nonvalvular atrial fibrillation（NVAf）. In ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation,the target intensity of international normalized ratio in warfarin therapy is 2.5 （ from 2.2 - 3.0 ） for most patients. Warfarin treatment using INR ranging from 1.6 to 2.5 （ target 2.0） is recommended for patients older than 75y with high risk of bleeding. There exists a racial difference in anticoagulation treatment between western and eastern patient populations. A recent trial in the China showed that in the Chinese patients with NVAf,the warfarin therapy （ INR 1. 6 - 2.5 ） for the prevention of thromboembolic events was superior to aspirin. Large clinical trials are warranted to investigate the optimal intensity of warfarin therapy in Chinese patient population with NVAf.