低相对分子质量肝素与华法令用于老年肺栓塞抗凝的疗效及出血风险

Effect of Low Molecular Weight Heparin and Warfarin Applied in Anticoagulant Therapy for Elderly Patients with Pulmonary Embolism and Risks of Bleeding

目的 观察低相对分子质量肝素（LMWH）与华法令用于老年肺栓塞（PE）抗凝的疗效及对出血风险的影响。方法 选取我院2011年5月到2015年5月收治的86例老年PE患者作为研究对象,分为对照组（n=43）与观察组（n=43）。对照组在对症治疗基础上皮下注射LMWH钙注射液进行治疗,观察组在对照组基础上于应用LMWH钙注射液2~3天后应用华法林,并从小剂量开始逐渐增加。之后停用LMWH钙注射液仅用华法林维持,两组治疗时间均为6个月。比较2组治疗总有效率、治疗前后凝血指标凝血酶原时间（PT）与活化部分凝血活酶时间（a PTT）及出血发生率。结果 观察组治疗总有效率为90.7%（39/43）,高于对照组74.4%（32/43）（P〈0.05）。2组治疗前的PT及a PTT的差异无统计学意义（P〉0.05）;治疗后2组PT及a PTT均延长,前后差异有统计学意义（P〈0.05）,且治疗后观察组PT与Aptt延长高于对照组（P〈0.05）。两组出血部位均以皮肤黏膜、胃肠道、泌尿生殖道为主,未出现严重出血事件。观察组出血发生率为20.9%（9/43）,高于对照组11.6%（5/43）,但差异无统计学意义（P〉0.05）。结论 LMWH与华法令治疗老年肺栓塞抗凝效果更佳,且出血风险不会明显增加。

Objective To observe the effect of low molecular weight heparin and warfarin fapplied in anticoagulant therapy for elderly patients with pulmonary embolism and the influence on risks of bleeding. Methods 86 cases of elderly patients with pulmonary embolism who were treated in our hospital between May 2011 and May 2015 were selected as the study objects. control group（ n = 43） and observation group（ n = 43）. The control group,based on the symptomatic treatment,was treated with subcutaneous injection of LMWHcalcium injection. On the basis of the treatment in the control group,the observation group was treated with LMWH calcium injection and 2 ~ 3 days later,was treated with warfarin. Besides,the dose was increased gradually from a small dose. Then,molecular weight heparin calcium injection was stopped and only warfarin was used for maintenance. Both of the two groups were treated for 6 months. The total effective rate,blood coagulation indexes[prothrombin time（ PT）,activated partial thromboplastin time（ a PTT） ]before and after treatment and incidence of bleeding were compared between the 2 groups. Results The total effective rate in the observation group[90. 7%（ 39 /43） ]was higher than that in the control group[74. 4%（ 32 /43） ]（ P〈0. 05）. There were no significant differences in PT and. a PTT between the 2 groups before treatment（ P〈0. 05）; After treatment,PT and a PTT of the 2 groups were both prolonged,and the differences before and after treatment were significant（ P〉0. 05）. After treatment,PT and a PTT of the observation group was longer than that of the control group（ P〉0. 05）. The main bleeding sites of the two groups were skin mucous membranes,gastrointestinal tract and genitourinary tract,and there were no serious bleeding events. The incidence of bleeding in the observation group[20. 9%（ 9 /43） ]was higher than that in the control group[11. 6%（ 5 /43） ],but the difference was not statistically significant（ P〉0. 05）. Conclusion The anticoagulant effect of LMWH and warfarin in the treatment of elderly patients with pulmonary embolism is better. The risk of bleeding will not increase significantly.