华法林的临床应用

Clinical application of warfarin

目的探讨华法林临床应用的安全性及最佳初始剂量。方法选取房颤患者81例,静脉血栓栓塞症患者63例,所有患者随机分入3.75 mg治疗组、2.5 mg治疗组和5 mg治疗组,各组患者均调整华法林剂量,使INR维持于2.0～3.0之间。随访2～6个月,观察各组患者达到稳定INR所需时间、维持稳定INR的华法林剂量,发生INR增高、出血/血栓栓塞事件。结果各组基线特征差异无显著性3,.75 mg治疗组达稳定INR的所需时间最短,华法林的维持剂量无显著性差别2,.5 mg治疗组、3.75 mg治疗组的发生INR增高、出血、血栓栓塞事件发生率无显著性差异,显著低于5 mg治疗组。结论对于我国患者,应用华法林以3.75 mg为初始剂量是安全、可行的,与2.5 mg、5 mg相比,疗效相似,而INR过高的发生较5 mg明显减少,与2.5 mg相似,且达到稳定INR的时间最短,3.75 mg可能是国人应用华法林的更佳初始剂量。

Objective： To study warfarin＇s clinical safety and the best initial dose.Methods： Eighty-one patients with atrial fibrillation and 63 patients with venous thromboembolism were chosen,and all the patients were randomly divided into 3.75 mg,2.5 mg and 5 mg treatment groups.The dose of warfarin was adjusted for the patients in each group,the INR was maintained at 2.0~3.0.In the Follow-up of 2~6 months the group of patients were observed in the time required to reach a stable INR,the warfarin dose for stable INR remaining,occurrence INR increase,bleeding and thromboembolic events.Results： Baseline characteristics between the groups were not significant,3.75 mg treatment group of stable INR took the shortest time,there was no significant difference in the maintenance dose of warfarin,and there was no significant difference in the incidence of INR,bleeding,blood clots increase in the 2.5 mg treatment group and 3.75 mg treatment group,which werer lower than those in the 5 mg.Conclusion： For our patients,the initial warfarin dose of 3.75 mg is safe,feasible,with efficacy being similar to that of 2.5 mg,5 mg,the significantly reduced occurrence of excessive INR being similar to that of 5mg and 2.5mg,and the shortest time of stable INR.3.75mg may be a better application of the initial warfarin dose for Chinese patients.