不同抗凝强度华法林对80岁及以上心房颤动患者的安全性研究

Safety study of different intensity anticoagulation therapy of warfarin in octogenarian patients with nonvalvular atrial fibrillation

目的探讨80岁及以上非瓣膜性心房颤动（房颤）患者使用不同抗凝强度华法林的安全性。方法130例老年持续性或永久性房颤患者被随机抽签分为3组：（1）低强度抗凝组国际标准化比率（INR）1．5～2．0；（2）中等强度抗凝组INR2．1～2．5；（3）阿司匹林组。观察3组的出血事件情况及对肾功能的影响。结果低强度抗凝组（35例）无致命性出血及严重出血，轻微出血2例（5．7％）；中等强度抗凝组（32例）致命性出血及严重出血各1例（3．1％），轻微出血4例（12．5％）；阿司匹林组（63例）致命性出血3例（4．8％），严重出血3例（4．8％），轻微出血7例（11．1％）。3组总出血率比较，差异有统计学意义（X^2=5．13，P〈O．05）。低强度抗凝组与中等强度抗凝组对肾功能的影响差异无统计学意义（P〉0．05），但两组明显优于阿司匹林组（P〈0．05）。结论80岁及以上房颤患者中，华法林抗凝INR值维持在1．5～2．0安全性好，对’肾功能影响较阿司匹林轻。

Objective To investigate the safety of different intensity anticoagulation therapy of warfarin in preventing thromboembolism in octogenarian patients with nonvalvular atrial fibrillation （NVAF）. Methods The 130 patients with persistent or permanent NVAF were randomly divided into three groups： low-intensity warfarin group （35 cases, international normalized ratio, INR （1.5-2.0）, moderate-intensity warfarin group （32 cases, INR 2.1-2.5） and aspirin control group （63 cases）. The rate of hemorrhagic events and the effect on renal function were observed. Results The incidence of hemorrhage was the lowest in low-intensity warfarin group compared to the other groups with slight bleeding in one case. life-threatening bleeding in one case, severe bleeding in one case and slight bleeding in four cases occurred in moderate-intensity warfarin group. Life-threatening bleeding in three cases, severe bleeding in two cases and slight bleeding in six cases occurred in aspirin control group. There were significant differences in bleeding incidence among the three groups （X^2== 5.13,P〈 O. 05）. The low-intensity warfarin group and moderate-intensity warfarin group were superior to the aspirin control group in the effect on renal function （P〈0.05）. Conclusions It is safe that the dose of warfarin is maintained at low anticoagulation intensity between INR 1.5 and 2.0 in octogenarians with NVAF.