华法林在非瓣膜性心房颤动抗凝治疗预防缺血性脑中风

Warfarin in Anticoagulation Therapy of Non-valvular Atrial Fibrillation to Prevent Ischemic Stroke

目的探讨华法林在非瓣膜性心房颤动患者抗凝治疗中预防缺血性脑中风效果及出血风险。方法整群选取2010年11月—2013年12月医院收治的172例非瓣膜性房颤患者为研究对象,按出血风险评分分为低危组及高危组,低危组口服华法林中等强度抗凝,国际标准化比率(INR)控制在2.0~3.0,高危组患者口服华法林低等强度抗凝,INR控制在1.5~2.5;观察记录两组患者治疗随访期间缺血性脑卒中风险与出血栓塞等不良反应情况。结果低危组缺血性脑卒中、短暂性脑缺血发作、外周动脉栓塞发生率(6.49%、2.60%、1.30%)与高危组(7.37%、3.16%、3.16%)比较,差异无统计学意义(P>0.05);低危组INR值(2.62±0.33),高危组INR值(1.86±0.31),两组比较差异有统计学意义(t=15.532,P<0.05);低危组死亡1例,高危组死亡2例,两组比较差异无统计学意义(P>0.05);低危组患者栓塞、出血、腹部不适发生率为9.09%、2.60%、1.30%,与高危组(9.47%、4.21%、2.11%)比较,差异无统计学意义(P>0.05);采用INR诊断患者出血风险,ROC曲线下面积为0.887(95%CI:0.827~0.946),INR的cut-off值2.85,该值下判断出血敏感性为81.1%,特异性为67.2%。结论华法林在非瓣膜性心房颤动患者抗凝治疗中,依据出血风险调整其抗凝强度可预防缺血性脑卒中及降低患者出血风险。

Objective This aim is to explore the effect of warfarin in anticoagulation therapy of patients with non-valvular atrial fibrillation, and its prevention of ischemic stroke and bleeding risk in patients. Methods A total of 172 patients with non-valvular atrial fibrillation from November 2010 to December 2013 in our hospital were selected. They were divided into low risk group and high-risk groups according to the bleeding risk score. Patients in low-risk group were given moderate-intensity warfarin anticoagu-lation, international normalized ratio(INR) was controlled in 2.0~3.0, patients in high-risk group were given low intensity warfarin anticoagulation, INR was controlled in 1.5 ~2.5. Adverse reactions and ischemic stroke risk in two groups of patients were recorded during follow-up. Results The ischemic stroke, transient ischemic attack, peripheral arterial embolism incidence in low-risk group was 6.49%, 2.60%, 1.30%, while it was 7.37%, 3.16%, 3.16% in the high-risk group, the difference was not statistically significance(P>0.05). INR value of low risk group was(2.62±0.33), which was(1.86±0.31) in high-risk group, there was statistical difference between the groups(t=15.532, P<0.05). One patient died in low-risk group, 2 deaths in high-risk group, which was no significant difference(P>0.05). Embolism, bleeding, abdominal discomfort incidence rate in low-risk group was 9.09%, 2.60%,1.30%, which was 9.47%, 4.21%, and 2.11% in high-risk group(P>0.05).The risk of bleeding in patients using INR diagnosis, the area under the ROC curve was 0.887(95% CI: 0.827 ~ 0.946), INR’s cut-off value was 2.85, sensitive and specificity in this value judgment of bleeding risk was 81.1% and 67.2%. Conclusion The results show that warfarin in anticoagulation therapy of patients with non-valvular atrial fibrillation may prevent ischemic stroke and reduce the risk of bleeding, which according to risk of bleeding adjusting its intensity of anticoagulation in patients.