非瓣膜性房颤抗凝治疗临床观察

Clinical observation of nonvalvular atrial fibrillation through anticoagulant therapy L

目的：探讨抗凝治疗非瓣膜性房颤（NVAF）的临床效果及药物选择。方法回顾性分析本院近5年内科住院治疗的NVAF患者96例,随机分为华法令组32例,予华法令1.25~5 mg/d,维持国际标准化比值（INR）2.0~3.0；通心络胶囊联合阿司匹林组32例,予通心络胶囊0.78 g,3次/d,阿司匹林片100 mg/d；阿司匹林组32例,予阿司匹林片100 mg/d。观察和比较三组患者脑栓塞及出血等并发症发生率,随访2年。结果脑栓塞年发病率华法令组（3.33%）与通心络胶囊联合阿司匹林组（5.0%）比较差异无统计学意义（P〉0.05）；阿司匹林组（17.2%）与通心络胶囊联合阿司匹林组比较差异有统计学意义（P〈0.05）；华法令组与阿司匹林组比较差异有统计学意义（P〈0.01）。华法令组有1例脑出血；通心络胶囊联合阿司匹林组有4例出现上腹痛、恶心,1例出现牙龈肿痛；阿司匹林组有3例出现上腹痛、恶心。结论通心络胶囊联合阿司匹林预防NVAF患者脑栓塞的效果和华法令比较差异无统计学意义,优于单用阿司匹林,无严重不良反应发生,且不需要监测凝血酶原时间（PT）和INR。不愿意接受华法令治疗的NVAF患者,给予通心络胶囊联合阿司匹林预防脑栓塞并发症是安全有效的。

Objective To explore the clinical effect and drug selection of nonvalvular atrial fibrillation （NVAF） by anticoagulation. Methods To analysis retrospectively the 96 NVAF patients with medical treatment in five years. The patients of warfarin group （n=32） took orally warfarin. The range of dosage was 1.25~5 mg/day and kept the INR between 2and 3. The patients of Tongxinluo capsule in combination with aspirin group （n=32） took orally Tongxinluo capsule （0.78 g,3 times a day） and aspirin （100 mg/d）;Patients of aspirin group （n=32） took orally aspirin （100 mg/day）. To observing and comparing the complication incidence of cerebral thromboembolism, hemorrhage etc, following up 2 years. Results The incidence of cerebral thromboembolism between warfarin group （3.33%/year） and Tongxinluo capsule combined with aspirin group （5.0%/year） had no remarkably significance （P〉0.05）.The result between aspirin group （17.2%/year） and Tongxinluo capsule combined with aspirin group had significance （P〈0.05）. The warfarin group between aspirin group had dramaticlly significance（P〈0.01）.The incidence of hemorrhage in warfarin group was 1.67%/year（n=1） and it was zero in the other two groups. Conclusion The effect of Tongxinluo capsule in combination with aspirin to prevent cerebral thromboembolism due to NVAF is same to that of warfarin and significantly better than that of aspirin.Tongxinluo capsule in combination with aspirin to prevent cerebral thromboembolism due to NVAF is safe and it does not need detecting INR. Tongxinluo capsule in combination with aspirin to prevent cerebral thromboembolism due to NVAF was effective and safety.