华法林与阿司匹林治疗重度心力衰竭合并持续性房颤患者的疗效比较

Curative effects of warfarin and aspirin in patients with severe heart failure complicating persistent atrial fibrillation

目的探讨华法林和阿司匹林在重度心力衰竭合并持续性心房颤动(AF)抗栓治疗中的临床疗效。方法回顾性纳入89例重度心力衰竭合并持续性AF患者,依据患者CHADS2评分及HAS-BLED评分情况给予不同的抗栓药物,分为两组:研究组(n=43),应用华法林治疗;对照组(n=46),应用阿司匹林治疗。比较两组患者缺血性事件(包括缺血性脑卒中、短暂性脑缺血发作、外周动脉栓塞)和出血事件(包括颅内出血、胃肠道出血、泌尿系出血)发生率的差异。结果与对照组比较,研究组患者缺血性脑卒中、短暂性脑缺血发作、外周动脉栓塞发生率显著降低,分别为:4.65%vs.15.22%、11.63%vs.21.74%、2.33%vs.8.69%,差异有统计学意义(P均<0.05);研究组与对照组出血性事件包括颅内出血、胃肠道出血、泌尿系出血发生率分别为:2.33%vs.2.17%、9.30%vs.10.86%、9.30%vs.8.69%,差异均无统计学意义(P>0.05)。随访1年,研究组与对照组患者猝死率分别为:6.98%vs.6.52%,差异无统计学意义(P>0.05)。结论依据CHADS2评分及HAS-BLED评分情况进行选择,华法林能降低重度心力衰竭合并持续性AF患者缺血性事件的发生率,而不增加出血性事件发生率。

Objective To investigate the curative effects of warfarin and aspirin during anticoagulant treatment in patients with severe heart failure complicating persistent atrial fibrillation （AF）. Methods The patients （n=89） were retrospectively chosen and divided, according to CHADS2 scoring, HAS-BLED scoring and different anticoagulant drug administrating, into research group （n=43） treated with warfarin and control group （n=46） treated with aspirin. The incidence rates of ischemia events （including ischemic stroke, transient cerebral ischemic attack and peripheral arterial embolism） and hemorrhagic events （including intracranial hemorrhage, gastrointestinal bleeding and urinary bleeding） were compared between 2 groups. Results The incidence rates of ischemic stroke, transient cerebral ischemic attack and peripheral arterial embolism decreased significantly in research group compared with control group （4.65% vs. 15.22%, 11.63% vs. 21.74% and 2.33% vs. 8.69%, all P〈0.05）. The incidence rates of intracranial hemorrhage, gastrointestinal bleeding and urinary bleeding were, respectively, 2.33%vs. 2.17%, 9.30%vs. 10.86%and 9.30%vs. 8.69%in research group and control group （P〉0.05）. After following up for 1 y, the sudden death rate was, respectively, 6.98%vs. 6.52%in research group and control group （P〉0.05）. Conclusion According to CHADS2 scoring and HAS-BLED scoring, warfarin can reduce the incidence of ischemia events and not increase that of hemorrhagic events in patients with severe heart failure complicating permanent AF.