华法林和阿司匹林预防血液透析长期静脉留置导管血栓栓塞的研究

Warfarin and aspirin in prevention of thromboembolism induced by long-term dwelling venous catheters during hemodialysis

目的 评价长期口服华法林和阿司匹林对血液透析长期静脉留置导管通畅率的影响。方法 选取行留置带袖套静脉导管（TCC）作为血管通路的终末期肾病透析患者120例,随机分为华法林组（A组）、阿司匹林组（B组）和对照组（C组）,各40例。阿司匹林组患者在TCC置入后口服阿司匹林100mg,每日1次;华法林组患者在TCC置入后24h口服华法林,维持INR在1.5～2.5之间;对照组在TCC置入后不接受任何抗凝或抗血小板药物。记录并比较三组患者的导管失功发生率,尿激酶干预次数和出血事件发生人数。结果 华法林组、阿司匹林组和对照组导管功能不良的的发生率分别为1.99%、3.26%和3.46%,华法林组和阿司匹林组、对照组比较（P〈0.05）,阿司匹林组和对照组比较（P〉0.05）。华法林组出现1例主要出血事件,2例次要出血事件,阿司匹林组和对照组无出血事件（P〈0.05）。结论 华法林比阿司匹林更能有效预防透析患者TCC的血栓栓塞,但由华法林引起的出血事件也应当引起足够重视。

Objective To investigate the effects of warfarin and aspirin on thromboembolism of long-term dwelling tunneled cuffed catheters （TCC）during hemodialysis. Methods We selected 120 patients with end-stage renal disease who received TCC as vascular pathway during hemodialysis in this study;they were randomly divided into 3 groups,40 cases in each group.Twenty-four hours after TCC was installed,patients in warfarin group （group A）received oral warfarin therapy to maintain INR between 1.5 and 2.5,while patients in aspirin group （group B）received oral aspirin 100mg daily,and patients in control group （group C）received neither anticoagulant nor antiplatelet drugs.The incidence rate of the catheter malfunction,the times of intervention with urokinase,and the number of people suffered bleeding event were recorded and compared. Results In our study,the incidence rate of the catheter malfunction was 1.99%,3.26% and 3.46% for warfa-rin group,aspirin group and control group,respectively,comparing warfarin group to aspirin group and con-trol group （P 〈0.05 ）,comparing aspirin group to control group （P〉0.05 ）.And one major bleeding e-vents,two minor bleeding events occurred in warfarin group （P 〈0.05）. Conclusion These results sugges-ted that warfarin is more effective in preventing TCC thromboembolism than aspirin,but the bleeding events caused by warfarin ought to be cautioned.