老年心房颤动高危患者抗凝治疗的药物选择及安全性

Drug selection in anticoagulation therapy for high-risk elderly atrial fibrillation patients and its safety

目的探讨老年心房颤动患者抗凝治疗的药物剂量选择及安全性。方法选择确诊的老年心房颤动患者210例,按照年龄将60～79岁130例作为老年段及≥80岁80例作为高龄段。2个年龄段患者按服药治疗不同分为老年华法林组30例、高龄华法林组30例,老年联合用药组50例(氯吡格雷75 mg+阿司匹林100 mg),老年阿司匹林组50例和高龄阿司匹林组50例(阿司匹林100 mg)。观察服用华法林剂量及国际标准化比值(INR);各组患者栓塞及出血发生率。结果高龄华法林组剂量(2.88±0.46)mg,INR 2.29±0.55,老年华法林组剂量(2.93±0.75)mg,INR 2.30±0.52,差异无统计学意义(P>0.05)。老年华法林组和高龄华法林组及老年联合用药组栓塞发生率明显低于老年阿司匹林组和高龄阿司匹林组(P<0.05)。与老年华法林组和高龄华法林组及老年阿司匹林组和高龄阿司匹林组比较,老年联合用药组出血发生率明显高(P<0.05)。结论老年心房颤动患者服用华法林或氯吡格雷+阿司匹林能更有效预防脑卒中事件的发生,老年、尤其是高龄高危患者服用华法林治疗,INR控制在1.5～2.5是安全、有效。对于不适合应用华法林的患者,可应用氯吡格雷+阿司匹林预防血栓形成。

Abstcact.Objective To study the drug dosage and its saftety in anticoagulation therapy for high- risk elderly atrial fibrillation patients. Methods A total of 210 elderly atrial fibrillation patients were divided into 60-79 years old group（n= 130） and 80 years old group（n：80）. The two groups were further divided into＊aged warfarin group（n= 30）,advanced age warfarin group（n： 30） ,combined age group（n=50）treated with 75 mg clopidogrel -b- 100 mg asprin,aged aspirin group（n=50） and advanced age aspirin group according to the drugs they took. The dosage of warfarin used, INR value,incidence of thrombosis and bleeding were observed in different groups. Results No significant difference was found in warfarin dosage and INR value between advanced age warfarin group and aged warfarin group（2.88±0.46 vs 2.93±0.75,2.29±0.55 vs 2.30± 0.52 ,P〉0.05）. The incidence of thrombosis was significantly lower in aged warfarin group, ad- vanced age warfarin group, and combined age group than in aged aspirin group and advanced age aspirin group （P〈 0.05）. The incidence of bleeding was significantly higher in aged warfarin group, advanced age warfarin group, aged aspirin group and advanced age aspirin group than in combined age group（P〈0. 05）. Conclusion Warfarin and clopidogrel q- asprin can effectively prevent cerebral stroke in elderly atrial fibrillation patients, especially in advanced high-risk elder- ly patients when the INR value is controlled at 1.5--2.5, and prevent thrombosis in those who cannot use warfarin.