老年非瓣膜性心房颤动抗凝治疗的体会及探讨

Experience and discussion of anticoagulation therapy in elderly patients with nVAF

目的探讨老年非瓣膜性心房颤动抗凝治疗的体会,为临床该类患者提供一种更为安全有效的抗凝治疗方案。方法我院收治的老年非瓣膜性心房颤动患者100例,据随机数字表法分为低强度组及标准强度组各50例。两组均予以华法林抗凝,低强度组国际标准化比值(INR)控制在1.5~2.0,标准强度组INR控制在2.1~3.0。比较两组治疗前后肾功能、出血性不良反应、临床终点事件及治疗依从性情况。结果两组治疗后各个时间段肌酐清除率(Ccr)水平均高于治疗前,两组治疗前后各个时间段Ccr水平比较,差异无统计学意义(均P>0.05)。低强度组出血性不良反应总发生率低于标准强度组,总体依从率高于标准强度组(P<0.05)。两组临床终点事件总发生率比较,差异无统计学意义(P>0.05)。结论华法林治疗INR控制在1.5~2.0的抗凝方案效果明显,且出血风险更小,患者治疗依从性更高,值得临床推广应用。

Objective To explore the experience of anticoagulation therapy for elderly patients with non-valvular atrial fibrillation(nVAF)in order to provide a more safe and effective anticoagulation therapy for clinical patients.Methods One hundred elderly patients with nVAF admitted to our hospital were included in the study.According to the random number table method,they were divided into low intensity group and standard intensity group,50 in each group.Warfarin anticoagulation was administered to both groups.The international standardized ratio(INR)of the low intensity group was controlled between 1.5 and 2.0,and the INR of the standard intensity group was controlled between 2.1 and 3.0.Renal function changes,hemorrhagic adverse reactions,clinical endpoint events,and treatment compliance were compared between the two groups before and after treatment.Results The creatinine clearance rate(CCR)of both groups at each time point after treatment was higher than that before treatment(all P<0.05),but the CCR at each time point before and after treatment was not significant between the two groups(all P>0.05).The total incidence of hemorrhagic adverse reactions was lower in the low intensity group than in the standard intensity group(P<0.05).The total incidence of clinical end point events was not significant between the two groups(P>0.05).The overall compliance rate of the low intensity group was higher than that of the standard intensity group(P<0.05).Conclusion Warfarin anticoagulant regimens with INR control between 1.5 and 2.0 are effective with less risk of bleeding and higher treatment compliance.It is worthy of clinical application.