华发令预防高龄非瓣膜病房颤血栓栓塞的效果及安全性

Efficacy and safety of Warfarin in aged patients with nonvalvular atrial fibrillation

目的观察华发令预防高龄非瓣膜病心房颤动（房颤）患者血栓栓塞的效果及安全性。方法选择2002年1月-2006年1月120例在我科住院的年龄≥75岁房颤患者，随机分为4组，A、B、C3组华发令口服剂量随国际准化比率（INR）调整，A组INR维持在1．5—2．0；B组INR维持在2．0—3．0；C组INR维持在1．5—2．0的同时给予阿司匹林100mg／d口服；D组给予阿司匹林100—200mg／a口服，随访时间18—48（32±8）月，随访内容使用统一表格，记录各项化验及其他辅助检查结果、终点事件发生时间等。结果A组栓塞事件1例（3％），D组6例（20％），B、C组无1例；A、D组出血事件各发生1例（3％），B组5例（17％），C组7例（23％）；D组死亡7例，C组死亡1例，P〈0．05。结论华发令抗凝强度INR为1．5—2．0时对预防高龄房颤患者血栓栓塞安全、有效，可供临床选择。

AIM To investigate the efficacy and safety of Warfarin in elderly patients with chronic nonvalvular atrial fibrillation. METHODS One hundred and twenty cases of aged patients were divided into four groups and were followed up for 32 8 months. Different doses of Warfarin were given to groups A, group B and group C according to International Normalized Ratio （INR）. The INR was 1.5 - 2.0 in group A, 2.0 - 3.0 in group B, and 1.5 - 2.0 in group C plus aspirin 100 mg/day. D group was given aspirin 100 - 200 mg/day. The results of biochemical and supplementary tests and the terminal occurrences were documented. RESULTS One case of thrombosis occurred in group A （3%）, 6 cases in group D （20%） and none in group B and group C. One case of hemorrhage occurred respectively group A and group D （3%）, 5 cases in group B （ 17% ） and 7 cases in group C （23%）. Seven cases of death occurred in group D and one case in group C （ P 〈 0.05 ）. CONCLUSION Warfarin is safe and effective when INR is between 1.5 - 2.0 in elderly patients with nonvalvular atrial fibrillation.