低强度华法林抗凝治疗老年CAD伴非瓣膜性房颤的效果观察

Observation on the Effect of Low Intensity Warfarin Anticoagulation in the Treatment of Elderly CAD Complicated with Non-Valvular Atrial Fibrillation

目的观察低强度华法林抗凝治疗老年冠状动脉粥样硬化性心脏病(CAD)伴非瓣膜性房颤的临床效果。方法110例老年CAD伴非瓣膜性房颤患者根据治疗方法的不同分为对照组(阿司匹林肠溶片)、低强度组(华法林钠片,初始剂量2.5mg/d)、标准强度组(华法林钠片,初始剂量5.0 mg/d),比较三组的肌酐清除率(Ccr)、终点事件发生情况。结果治疗6、12、24个月后,低强度组、标准强度组的Ccr均高于对照组(P<0.05),但低强度组与标准强度组的Ccr比较,差异无统计学意义(P>0.05)。治疗24个月后,低强度组的缺血性脑卒中发生率低于其他两组(P<0.05)。结论与阿司匹林治疗相比,华法林抗凝治疗对老年CAD伴非瓣膜性房颤患者的肾脏功能影响较小,低强度华法林抗凝治疗能显著减少缺血性脑卒中的发生。

Objective To observe the clinical effect of low intensity warfarin anticoagulation in the treatment of elderly coronary atherosclerotic heart disease(CAD)complicated with non-valvular atrial fibrillation.Methods According to different treatment methods,110 elderly CAD patients with non-valvular atrial fibrillation were divided into the control group(aspirin enteric-coated tablets),low-intensity group(warfarin sodium tablets,initial dose of 2.5 mg/d)and standard-intensity group(warfarin sodium tablets,initial dose of 5.0 mg/d).The creatinine clearance rate(Ccr)and the occurrence of endpoint events were compared among the three groups.Results After 6,12 and 24months of treatment,the Ccr in the control group was lower than that in the low-intensity group and standard-intensity group(P<0.05);No significant difference was found in Ccr between the low-intensity group and standard-intensity group(P>0.05).After 24 months of treatment,the incidence of ischemic stroke in the low intensity group was lower than that in the other two groups(P<0.05).Conclusions Compared with aspirin therapy,warfarin anticoagulation therapy has less impact on renal function of elderly CAD patients with non-valvular atrial fibrillation.Low-intensity warfarin anticoagulation therapy can significantly reduce the incidence of ischemic stroke.