华法林治疗脑梗死合并房颤的疗效及安全性

Efficacy and safety of warfarin therapy for patients with cerebral infraction accompanying atrial fibrillation

目的探讨华法林在60岁以上老年脑梗死并房颤患者中长期应用的疗效及安全性。方法选择2011-05—2015-05在我院神经内科住院的房颤伴脑梗死高危患者40例,长期应用华法林治疗,观察患者治疗前后凝血指标变化及出血情况。结果治疗1周、1个月、3个月的凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、国际标准化比值(INR)与治疗前比较差异有统计学意义(P<0.05)。随访15个月,牙龈出血1例,皮肤黏膜瘀斑2例,消化道出血1例,出现痰中带血1例,出现脑梗死1例,未出现脑出血及其他严重出血并发症。结论华法林在60岁以上老年脑梗死伴非瓣膜性房颤中应用效果显著,出血不良反应小,梗死发生率低,且老年抗凝强度INR维持在1.8~2.5安全有效。

Objective To investigate the efficacy and safety of warfarin sodium tablet therapy among patients with cerebral infarction accompanying atrial fibrillation over 60 years old. Methods Forty patients with atrial fibrillation and cerebral infarction were included in our study. All were given a long-term therapy with warfarin sodium tablets. The changes of coagulation parame- ters and bleeding events were observed before and after the treatment. Results The levels of prothrombin time （PT）,activated partial thrombin time （APTT） and international normalized ratio （INR） were significantly different from those before treatment （P〈0.05）. Complications occurred in 6 cases including 1 case of gingival bleeding,2 cases of skin and mucous plaques, 1 case of gastrointestinal bleeding, 1 case of bloody sputum and 1 case of cerebral infarction. No cerebral hemorrhage and other severe bleed ing complications occur. Conclusion The effect of warfarin sodium tablet on aged patients with cerebral infarction accompanying nonvalvular atrial fibrillation was significant. The incidence of bleeding events and cerebral infarction was low and the optimal INR range of aged patients was considered between 1.8 and 2.5. At the same time,the doctor＇s attention to the therapeutic roles of war- farin, accurate laboratory monitoring, good compliance of patients, active cooperation of the families are essential to improve the ef- ficacy of treatment and reduce the risk of bleeding complications.