非瓣膜病房颤患者不同强度抗凝的疗效分析

Efficacy Analysis of the Different Intensity of Anticoagulation in Patients with Non-valvular Atrial Fibrillation

目的分析非瓣膜病房颤患者不同强度抗凝的治疗效果。方法把我院2005年1月到2011年10月有效随访的236例非瓣膜病房颤患者,分成四组,第一组61例,采用阿司匹林(100mg/d)抗凝治疗;第二组54例,采用华法林(INR1.5-2.0)抗凝治疗;第三组63例,采用华法林(INR2.01-2.5)抗凝治疗;第四组58例,采用华法林(INR2.51-3.0)抗凝治疗。最后对四组患者在随访期内的血栓事件及出血事件进行比较。结果第一组患者的栓塞事件发生率为13.1%,高于其他各组,差异有显著性(P<0.05),第四组栓塞事件发生率为1.7%,低于其他组,差异有显著性(P<0.05)。第四组严重血事件发生率10.3%,高于其他各组(P<0.05),而第一组无严重出血事件发生,低于其他组,差异有显著性(P<0.05),但在总出血发生率上四组比较差异无显著性(P>0.05)。结论在非瓣膜病房颤患者抗凝治疗中,华法林预防栓塞疗效优于阿司匹林,随INR强度上升栓塞事件发生降低,但严重出血风险升高,INR1.5-2.5时有效且安全,推荐国人采用。

Objective To analyze the treatment effects of atrial fibrillation patients with non-valvular disease treated by antieoagulation with different strength. Method From January 2005 to October 2011, 236 randomly selected atrial fibrillation patients with non-valvular disease are divided into 4 groups. Group 1 with 61 cases treated by aspirin（100mg/d） anticoagulation, Group 2 with 54 cases treated by warfarin （INR1.5-2.0） anticoagulation, Group 3 with 63 cases treated by warfarin （INR2.01-2.5） anticoagulation, Group 4 58 cases treated by warfarin （INR2.51-3.0） anticoagulation. At last, the events of thrombus and bleeding among 4 groups during research is compared. Result The incidence rate of thrombus in Group 1 is 13.1% which is higher than the other groups, difference is significant（P〈0.05）, while that in Group 4 is 1.7% which is lower than the other groups, difference is significant（P〈0.05）. The incidence rate of serious bleeding in Group 4 is 10.3% which is higher than the other groups（P〈0.05）, while there is no serious bleeding in Group 1 which is lower than the other groups, difference is significant（P〈0.05）. But at the aspect of total bleeding rate, difference among 4 groups is no significance （P〉0.05）. Conclusion In the anticoagulation treatment of atrial fibrillation patients with non-valvular disease, embolism prevention by warfarin is better than aspirin, although the incidence rate of embolism will decrease with 1NR strength rising, the risk of serious bleeding will increase, INR1.5-2.5, effective and safe, is worth recommending.