华法林对下肢深静脉血栓的抗凝作用及影响因素分析

Analysis of Anticoagulation Effects and Influential Factors of Warfarin on the Lower Extremity Deep Venous Thrombosis

目的:探讨华法林对下肢深静脉血栓(LEDVT)的抗凝作用,并分析其影响因素,为指导华法林个体化用药提供参考。方法:140例急性LEDVT患者,入院后第2天开始给予华法林钠片,首剂量为5.0 mg,每日1次,后2 d剂量为2.5 mg,口服,每日1次。给药72 h后根据患者国际标准化比值(INR)调整华法林剂量,以INR达到抗凝目标时的华法林剂量作为维持剂量长期服用。记录患者临床资料,并检测血液生化指标及凝血四项,采用多重线性回归法分析抗凝作用的影响因素;同时,记录给药前及给药后24、48、72 h INR值。结果:给药后,患者的INR值均高于给药前,且给药后24、48、72 h的INR值呈逐渐上升趋势,但差异均无统计学意义(P>0.05);给药后24 h内的INR差值显著小于给药后24~48 h的INR差值,而24~48 h的INR差值显著小于48~72 h的INR差值,差异均有统计学意义(P<0.01);各因素对华法林抗凝作用的影响从大到小依次为:年龄、体质量、低密度脂蛋白胆固醇、血浆白蛋白、病程。其中,年龄和低密度脂蛋白胆固醇与抗凝作用呈正相关,体质量、血浆白蛋白和病程与抗凝作用呈负相关。结论:年龄、体质量是影响华法林抗凝作用的主要因素,临床应实施个体化给药,以提高华法林抗凝效果。

OBJECTIVE： To investigate the anticoagulation effects of warfarin on the lower extremity deep venous thrombosis （LEDVT）, and to analyze its influential factors, in order to provide scientific basis for individualized medication of warfarin in the clinic. METHODS： Totally 140 cases of LEDVT were selected and treated with warfarin on the and day after admission with initial dose of 5.0 mg, qd, 2.5 mg for following 2 days, orally, qd. The dose of warfarin was adjusted 72 h after medieation according to INR of patients. The dose of warfarin wasused as the maintenance dose when INR reached the anticoagulant target. Clinical data of patients were recorded, and blood biochemical indexes and coagulation function were detected. The influential factors of anticoagulation effects were analyzed by multiple-linear regression. At the same time, the results of INR were recorded before medication and 24, 48, 72 h after medication. RESULTS： INR of patients receiving warfarin had the potential to increase, compared to before medication; 24, 48, 72 h after medication, INR value showed a gradual upward trend, without statistical significance （P〉0.05）. The change of INR within 24 h after medication was less than that within 24-48 h after medication; the change of INR within 24-48 h after medication was less than that within 48-72 h after medication, with statistical significance （P〈0.01）. The influence of various factors on the anticoagulant effect of warfarin in descending order was as follows： age, weight, low density lipoprotein cholesterol, plasma albumin, disease duration. Among them, age and low density lipoprotein cholesterol were positively correlated with anticoagulation, while body weight, plasma albumin and disease duration were negatively correlated with anticoagulation. CONCLUSIONS： Both age and body weight are the main influential factors for anticoagulation effect of warfarin. Individualized medication should be implemented in order to improve the anticoagulation effects of warfarin.