不同强度华法林在冠状动脉粥样硬化性心脏病并发心房颤动患者中的效果对比

Effects of different intensities of warfarin on patients with coronary atherosclerotic heart disease complicated with atrial fibrillation: a comparative study

目的:探讨不同强度华法林在冠状动脉粥样硬化性心脏病并发心房颤动患者中的效果。方法:选取2011年6月到2013年7月期间我院收治的冠状动脉粥样硬化性心脏病并发心房颤动患者107例,采取随机数字表的方式将患者随机分成对照组和试验组;试验组54例,对照组53例;试验组(低强度)初始量1.25 mg/d,服药后24 h开始监测国际标准化比值(INR),若INR<1.4,3~5 mg/d增加0.5~1.0 mg/d,1周监测1次,INR维持1.4~2.0。对照组(中强度)INR维持2.0~2.6。INR稳定后监测1次/月。所有患者都经过约4周的调整时间,华法林维持剂量1.25~7.5mg/d;观察比较两组治疗2年后主要终点和次要终点及出血事件。结果:试验组和对照组INR分别为1.71±0.38、2.36±0.35,试验组低于对照组,差异有统计学意义(P<0.05);试验组和对照组的总出血事件比例为22.2%、41.5%,试验组低于对照组,差异有统计学意义(P<0.05)。结论:低强度的华法林治疗冠状动脉粥样硬化性心脏病并发心房颤动的治疗效果与中强度华法林治疗的效果相当,但低强度的华法林的安全性更高。

AIM： To explore the effects of different intensity of warfarin on patients with coronary atherosclerotic heart disease complicated with atrial fibrillation.METHODS： One hundred and seven cases of coronary heart disease complicated with atrial fibrillation patients in our hospital were selected and were randomly divided into experimental group（ n = 54） and control group（ n = 53） by random number table.The experimental group（ low intensity） received initial amount of warfarin for 1.25 mg/d,and NR monitoring 24 h after treatment,if INR 1.4,3-5 mg/d increased by 0.5-1.0 mg/d,monitoring one time per week,INR maintained within 1.4-2.0.INR of the control group（ medium intensity） maintained within 2.0-2.6.One month monitoring after INR stabilized.All patients were treated for about 4 weeks,and warfarin was maintained at a dose of 1.25-7.5 mg/d.The primary and secondary end points and bleeding events were observed and compared after 2 years of treatment.RESULTS：The INR of the experimental group and the control group were 1.71 ± 0.38,2.36 ± 0.35,respectively.The ratio of total bleeding event of the experimental group and the control group was 22.2% and41.5%, respectively.Those of the experimental group were lower than those of the control group,and the difference was all statistically significant（ P〈0.05）.CONCLUSION： The efficacy of low-intensity warfarin in the treatment of coronary atherosclerotic heart disease complicated with atrial fibrillation is comparable to that of moderate-intensity warfarin therapy,but low-intensity warfarin shows better saftey.