华法林联合阿托伐他汀对心房颤动患者脑血栓的预防作用

Prevention effect of warfarin combined with atorvastatin on cerebral thrombosis in patients with atrial fibrillation

目的探讨华法林联合阿托伐他汀对心房颤动(atrial fibrillation,AF)患者脑血栓的预防作用。方法选取90例AF患者,根据华法林抗凝治疗强度分为低强度组(n=45)及标准强度组(n=45),2组均予以阿托伐他汀治疗,低强度组开始予以华法林1.25 mg,国际标准化比值(standard international normalized ratio,INR)达标范围为1.5~2.1;标准强度组开始予以华法林2.5 mg,INR达标范围为2.2~2.7。所有患者均随访1年,比较2组治疗前后的凝血功能指标、临床复合终点事件、安全终点事件、INR及华法林维持剂量。结果治疗后,2组纤维蛋白原(fibrinogen,FIB)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)和凝血酶原时间(prothrombin time,PT)均高(长)于治疗前(P<0.05),但2组比较差异无统计学意义(P>0.05);2组临床复合终点事件发生率比较,差异无统计学意义(P>0.05);低强度组牙龈出血、皮肤黏膜出血发生率分别为4.44%、8.89%,均低于标准强度组(17.78%、24.44%),P<0.05;低强度组INR及华法林维持剂量均低于标准强度组(P<0.05)。结论不同强度华法林联合阿托伐他汀在AF患者抗凝治疗中的疗效相当,2种方法有相似的临床复合终点事件发生率,但低强度华法林联合阿托伐他汀治疗有利于预防出血。

Objective To explore the prevention effect of warfarin combined with atorvastatin on cerebral thrombosis in patients with atrial fibrillation(AF).Methods According to different intensity of warfarin,90 patients with AF were divided into low-intensity group(n=45)and standard intensity group(n=45),both groups were treated with atorvastain,and the low-intensity group was initially treated with warfarin 1.25 mg,the standard international normalized ratio(INR)range was 1.5-2.1.The standard-intensity group began to receive 2.5 mg of warfarin,with an INR compliance range of 2.2-2.7.All patients were followed up for 1 year.The coagulation function indexes,clinical composite endpoint events,safety endpoint events,INR and maintenance dose of warfarin were compared between the 2 groups before and after treatment.Results After treatment,the fibrinogen(FIB),activated partial thromboplastin time(APTT)and prothrombin time(PT)in both groups were higher(longer)than before tretment(P<0.05),but there was no significant difference between the 2 groups(P>0.05).There was no significant difference in the incidence of clinical composite endpoint events between the 2 groups(P>0.05).The incidence rates of gingival bleeding and skin mucosa bleeding in lowintensity group were 4.44%and 8.89%,lower than those in standard-intensity group(17.78%,24.44%,P<0.05).The INR and maintenance dose of warfarin in low-intensity group were lower than those in standard-intensity group(P<0.05).Conclusion Different intensity of warfarin combined with atorvastatin for anticoagulant therapy has similar curative effect in AF patients.The 2 methods have similar clinical composite endpoint time incidence rates.However,low-intensity warfarin combined with atorvastatin is beneficial to prevent bleeding.