低剂量华法林对心房颤动患者脑卒中和凝血指标的影响

Effects of low dose warfarin on stroke and coagulation indexes in patients with atrial fibrillation

目的探讨心房颤动患者低剂量长期使用华法林对患者脑卒中和凝血指标的影响。方法选择2016年1月—2018年12月喀什地区第一人民医院收治的心房颤动患者213例作为研究对象,按照随机数字表法将患者分为3组,每组各71例。对照组患者使用阿司匹林肠溶片,200 mg/d。华法林高剂量组患者在使用华法林钠片前测定抗凝强度国际化标准比率(INR)作为基础值,初始剂量为2.5 mg/d,每隔3~5 d复查IRN,根据IRN调整使用剂量,每次增加0.625 mg,直至复查INR达标,达标时IRN值为2.1~3.0。华法林低剂量组患者使用华法林初始量为1.25 mg/d,每隔3~5 d复查IRN,达标时IRN值为1.5~2.0。根据IRN调整使用剂量,如果INR<1.5,每次增加0.625 mg,直至复查INR达标;如果INR>2.1,将华法林剂量减少0.625 mg。INR不稳定时,连续达标2次后以该剂量作为维持剂量,每月复查1次,直至INR达标。3组均治疗随访18个月。观察并比较两组患者的脑卒中发生情况、凝血指标、华法林用量、达INR标准时间和不良反应发生情况。结果随访后,华法林高剂量组脑卒中发生率为2.82%,华法林低剂量组为4.23%,均明显低于对照组的14.08%,组间差异具有统计学意义(P<0.05)。治疗后,3组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)均明显延长(P<0.05),华法林高剂量和低剂量APTT、PT显著优于对照组,组间差异具有统计学意义(P<0.05)。华法林低剂量组华法林使用量和INR达标准值时间均明显低于华法林高剂量组(P<0.05)。治疗期间,华法林高剂量组出血、腹部不适等不良反应发生率为9.86%,华法林低剂量组为5.63%,均明显低于对照组的29.58%(P<0.05)。结论心房颤动患者长期使用低剂量华法林能够有效的达到预防脑卒中的效果,其疗效与标准抗凝强度相当,且明显优于阿司匹林,具有较高的临床应用价值,可推广使用。

Objective To investigate the effects of long-term low-dose warfarin on stroke and coagulation indexes in patients with atrial fibrillation.Methods A total of 213 patients with atrial fibrillation admitted to the the First People’s Hospital in Kashgar from January 2016 to December 2018 were selected as the research objects,and the patients were divided into 3 groups according to the random number table method,with 71 patients in each group.Patients in the control group were po administered with Aspirin Enteric-coated Tablets at 200 mg/d.In the high-dose warfarin group,INR was measured as the base value before the use of Warfarin Sodium Tablets.The initial dose was 2.5 mg/d,and IRN was rechecked every 3 to 5 days.The dosage should be adjusted according to IRN and increased by 0.625 mg each time until the INR was rechecked,and the IRN value was 2.1—3.0.Patients in the lowdose warfarin group,the initial dose of warfarin was 1.25 mg/d,and IRN was checked every 3 to 5 days,and the IRN value was 1.5 to 2.0 when the target was reached.Adjust the dosage according to IRN.If INR<1.5,increase 0.625 mg each time until INR meets the standard.If INR>2.1,the warfarin dose was reduced by 0.625 mg.When INR is unstable,the dose shall be used as the maintenance dose after reaching the standard for two consecutive times,and the dose shall be reviewed once a month until reaching the standard for INR.All the 3 groups were followed up for 18 months.The incidence of stroke,coagulation indexes,warfarin dosage,time to INR standard,and adverse reactions were observed and compared between two groups.Results After follow-up,the incidence of stroke was 2.82%in the high-dose warfarin group and 4.23%in the low-dose warfarin group,both of which were significantly lower than 14.08%in the control group,with statistically significant difference between the two groups(P<0.05).After treatment,APTT and PT in three groups were significantly prolonged(P<0.05),and APTT and PT at high and low doses of warfarin were significantly better than those in the control group,with statistically significant differences between groups(P<0.05).The dosage of warfarin and the time for INR to reach the standard value in low-dose warfarin group were significantly lower than those in the high-dose warfarin group(P<0.05).During the treatment,the incidence of adverse reactions,such as bleeding and abdominal discomfort,was 9.86%in the high-dose warfarin group,and 5.63%in the low-dose warfarin group,which were significantly lower than 29.58%in the control group(P<0.05).Long-term use of low-dose warfarin in patients with atrial fibrillation can effectively achieve the effect of preventing stroke.Its efficacy is comparable to standard anticoagulant intensity,and significantly superior to aspirin.Conclusion It has high clinical application value and can be widely used.