华法林对超高龄患者抗凝治疗价值研究

Warfarin for anticoagulantion in patients aged over 80 years:a clinical study

目的分析华法林抗凝治疗在80岁以上患者中临床应用的现状,评价其临床适应证、疗效及风险,探讨在超高龄患者中华法林的合理应用方法。方法回顾性分析2006年1月至2010年12月于北京大学第一医院心内科31例华法林抗凝治疗的80岁以上患者的临床资料,总结华法林的起始及维持剂量、国际标准比值(INR)监测及栓塞和出血事件的发生。结果 93.55%患者均属于被动抗栓治疗。70.97%的患者INR达2.0～3.0,70.97%的患者达标剂量<3 mg/d,41.94%的患者维持1.5 mg起始剂量。发生缺血性卒中2例,INR<2.0;出血事件2例,INR>2.5。结论 80岁以上超高龄患者的华法林抗凝治疗,1.5 mg/d的起始剂量安全有效;INR维持在2.0～2.5较为适宜。

Objective To analyse the clinical conditions of anticoagulant therapy using warfarin in patients aged over 80 years for further assessment of clinical indications, efficacy and side effects, thus offering rationale for clinical application. Methods We did a retrospective analysis on the clinical profiles of 31 patients aged over 80 years treated with warfarin an- ticoagulant therapy in the department of cardiology, First Hospital of Peking University between January 2006 and December 2010. Initiation, dosage for maintenance ,monitoring of international ratio （INR） and events of thromboembolism and bleed- ing were evaluated. Results 93.55% of patients received warfarin therapy passively. 70. 97% of patients were noted as having INR between 2.0 and 3.0,70. 97% of patients treated with 〈 3 mg/d warfarin achieved ideal control and 41.94% of patients were on maintenance therapy using the initial dosage of 1.5 mg/d. Ischemic stroke was reported in 2 patients who had INR 〈 2. 0. Contrarily,INR 〉 2. 5 was associated with incidence of hemorrhage in 2 patients. Conclusion Given an appropriate INR between 2. 0 and 2. 5 for maintenance, warfarin with an initial dosage of 1.5 mg/d is safe and effective for paients aged over 80 years.