华法令与阿司匹林预防心房颤动患者血栓栓塞的临床分析

Clinical Analysis of Effect in Preventing Thrombebolia in Atrial Fibrillation Patients by Warfarin and Asp

目的比较阿司匹林与调整剂量华法令预防非瓣膜性心房颤动（房颤）患者发生血栓栓塞的有效性和安全性。方珐根据入选标准将非瓣膜性房颤患者随机分配至阿司匹林组（100—150mg／a）19例和调整剂量华法令组[初始剂量2．5mg／d，目标国际标准化比值（INR）为2．0-3．0，年龄≥75岁者的INR为1．8-2．5]38例。常规门诊随访，调整华法令剂量并记录两组患者缺血性脑卒中及出血情况。结果对57例患者进入分析，平均年龄（67．2±9．5）岁，阿司匹林组19例，华法令组38例。男性30例（52．6％），女性27例（47．4％），两组患者基线特征（包括合并疾病和伴随用药）差异无统计学意义。随访时间中位数24个月（2-36个月）。华法令组发生脑栓塞1例，发生率为2．63％。阿司匹林组发生脑栓塞4例，发生率15．79％。两组有明显的统计学差别（P〈0．05）。华法令组有3例发生出血事件，发生率为7．9％，发生时INR均〉3．0。阿司匹林组有1例发生出血事件，发生率为5．2％，虽然华法令组的出血发生率高于阿司匹林组，但没有统计学差另1。结论与阿司匹林相比，华法令可明显降低非瓣膜性房颤患者脑卒中的发生率，华法令组出血的发生率虽高于阿司匹林组，但出血并发症发生在INR〉3．0。严密监测（INR2．0—3．0）下的调整剂量华法令安全有效。

Objective To compare the efficacy and safety in preventing thrombebolia in atrial fibrillation patients by Warfarin and Asp. Methods The patients of non - valve atrial fibrillation be assign two group by formulated standard, one group was 19 cases patients treated by Asp（ 100 - 150 mg/d）, another group was 38 cases patients treated by Warlatin（Initial dose was 2.5 mg/d, INR was 2.0 - 3.0,but INR was 1.8 - 2.5 in patients surpassed 70 years old） .The patients were routine followed up in OPD and adjusted Warfarin dos, the patients of stroke and bleeding be recorded. Results 57 eases be analyzed , the mean age was （67.2 ± 9.5） years old., the group of Asp were 19 cases, the group of Warfarin were 38 cases.The male are 30 cases（52.6% ） ,but femail were 27 cases（47.4% ） ,The difference of base- line character of two groups had not statistical significance, included assiden disease and assiden drugs. The follow - up visit time was 24h （2 - 36 h） .The number of cerebral embolism was 1 case in the group of Warfarin,the incidence rate was 2.63%. The number of cerebral embolism was 4 case in the group of Asp, the incidence rate was 15.79%. The difference had statistical significance（ P 〈 0.05）. The number of bleeding were 3 cases, the incidence rate was 7.9% （INR 〉 3.0）. The number of bleeding was 1 cases, the incidence rate was 5.2%, The difference had not statistical significance. Conclusion To compared with Asp, Warfarin can evident decrease the incidence rate of stroke in atrial fibrillation patients. The incidence rate bleeding is more higher in the group of Warfarin compared with the group of Asp, but it happened in INR 〉 3.0. Warfarin is safe and effective in adjusting dos （INR2.0 - 3.0） under monitoring.