心房颤动伴脑栓塞患者行不同治疗方案的复发情况

Comparison of stroke recurrences in cardiogenic cerebral embolism during atrial fibrillation during different preventive and therapeutic regimens

目的探讨华法林、阿司匹林、阿司匹林联用氯吡格雷在伴有心房颤动的心源性脑栓塞二级预防中的临床疗效。方法收集130例伴有心房颤动的心源性脑栓塞患者的临床资料，根据出院口服抗栓药物不同分组，分为阿司匹林组45例，给予阿司匹林100 mg／d；华法林组49例，以起始计量2．5 mg／d，4 d后根据监测INR调整剂量，若INR未达2．0～2．5者，每次增加华法林0．625～1．25 mg，直到INR2．0～2．5；阿司匹林＋氯吡格雷组36例，予以阿司匹林100 mg／d氯吡格雷75 mg／d口服。通过电话随访，对3组患者出院后9个月卒中再发情况和各组出血情况进行统计分析。结果华法林组复发脑梗死3例，阿司匹林组复发脑梗死11例，阿司匹林＋氯吡格雷组复发脑梗死5例，差异有统计学意义。三组均无致命性出血，其中华法林组有出血并发症6例（12．2％），阿司匹林组出血2例（4．4％），阿司匹林＋氯吡格雷组出血5例（13．9％），三组出血差异无统计学意义。结论华法林在脑栓塞二级预防中疗效优于阿司匹林以及阿司匹林联用氯吡格雷。

Objective To explore the clinical curative effect of warfarin,aspirin,aspirin and clopidogrel in secondary prevention of cardioembolic stroke with atrial fibrillation.Methods Patients with cardioembolic stroke with atrial fibrillation discharged form our hospital between January 2011 and April 2014 were assigned to aspirin group （100 mg/d）,warfarin group （2.8 ＆#177;0.5 mg）,the International Normalised Ratio between 2.0-2.5 were the thera-peutic strength）,aspirin（100 mg/d） ＋clopidogrel（75 mg/d） group.Telephone follow up patients of three groups a-bout recurrence of cerebral embolism and the rate of hemorrhage.Results A total of 130 patients were included in the analysis,45 patients in aspirin group,49 patients in warfrin group,36 patients in aspirin and clopidogrel group.No statisticlly significant difference between the three groups of patients with baseline characteristics （ include sex,age, combine disease,CHADS2 scores,HAS-BLED scores） .The recurrence of cerebral infarction in aspirin group,warfa-rin group,aspirin and clopidogrel group was 11 patients,3 patients,5 patients.The difference was statistically signifi-cant.No fatal bleeding occurred in three groups.Wafarin group had 6 patients of bleeding （12.2 %）,aspirin group had 2 patients of bleeding（4.4 %）,aspirin and clopidogrel group had 5 patients of bleeding （13.9 %）.The rate of hemorrhage in wafarin group and double resistant group was higher than aspirin group,but the difference of hemor-rhage was not statistically significant between three groups.Conclusion Wafarin is superior to aspirin or aspirin com-bine clopidogrel in the secondary prevention of cerebral embolism.