老年人非瓣膜病心房颤动患者华法林5mg起始治疗的有效性及安全性

Effectivenesst and safety of 5 mg/d warfarin initial therapy in elderly patients with nonvalvular atrial fibrillation

目的探讨老年人非瓣膜病心房颤动(NVAF)患者应用华法林5 mg起始治疗的疗效及安全性。方法入选具有华法林抗凝适应证的NVAF老年患者91例,随机分为2组,分别以5 mg/d或3 mg/d起始治疗,于治疗前、治疗后第3、4、5、8天测定国际标准化比值(INR),根据INR调整服药剂量,至INR稳定。结果 5 mg/d起始治疗第3、4、5、8天INR的达标率分别为3.9%、29.4%、43.1%和72.5%,INR达稳定时间为(9.8±2.3)d,与3 mg/d组0%、5%、22.5%、50%[(12.5±2.7)d]比较,差异有统计学意义(均P<0.05),出血发生率两组差异无统计学意义。结论 5 mg/d起始,连续4 d的华法林起始治疗方案能使INR迅速、安全、有效地达到稳定,无严重出血并发症发生。

Objective To evaluate the effects and safety of 5mg/d warfarin initial Therapy in patients with nonvalvular atrial fibrillation （NVAF）. Methods A total of 91 patients who had the indication of anticoagulation therapy were randomly assigned to either 3mg/d or 5mg/d initial dosage warfarin therapy group. International normalized ration （INR） was determined before and 3, 4, 5 and 8 days after warfarin therapy. The dosage of warfarin was adjusted according to the 1NR results until it was stable to 1.8 to 2.4 （ target INR）. Results The rates of reaching target 1NR in 5 mg/d group and 3 mg/d group were 3.9% vs. 0% at day 3, 29. 4% vs. 5% at day 4, 43. 1% 22. 5% at day 5 and 72. 5% vs. 50% at day 8, respectively （all P 〈0. 05）. Compared with 3 mg/d group [ （ 12. 5 -±2.3） d], the time to target INR was significantly shorter in 5 mg/d group [ （9. 8 ± 2. 3 ） d, P 〈 0. 05 ]. There was no significant difference in the incidence of bleeding between the 2 groups （ 13.7% in 5 mg/d group vs. 10% in 3 mg/d group, P 〉 0.05 ）. Conclusion Compared with 3 mg/d initial therapy, 5 mg/d initial therapy with warfarin can reach the target INR more quickly, without increasing the severe bleeding complications.