华法林对中国人心房颤动患者抗栓的安全性和有效性研究

The efficiency and safety of anticoagulation therapy in atrial fibrillation in Chinese

目的 通过回顾性分析心房颤动 (房颤 )患者的抗栓治疗 ,初步探讨中国人华法林国际标准化率 (INR)的合理范围。方法 调查 4 35例房颤患者应用华法林抗凝及INR监测情况 ,分析出血和血栓栓塞事件的危险因素及与INR的关系。结果 华法林疗程时间中位数 7个月 ,平均剂量为(2 77± 0 83)mg。共发生出血事件 31例 (7 11% ) ,其中严重出血 5例 ,轻微出血 2 6例。发生出血患者年龄略高于对照组 [(6 5 1± 10 0 )岁与 (6 2 0± 12 2岁 ) ],但差异无统计学意义 (P =0 2 5 9) ;出血患者血压高于对照组 ,合并心力衰竭较多 (P =0 0 5 )。多因素分析中INR≥ 3为预测出血的独立危险因素 (OR =3 74 )。血栓栓塞事件 37(17 4 7% )例 ,发生缺血性卒中或栓塞的危险随INR下降明显增加。结论 房颤患者华法林抗凝目标INR值应避免低于 1 5或高于 3 0。

Objective To determine the strength of oral anticoagulation therapy in atrial fibrillation that provides the best balance between the prevention of thromboembolism and the occurrence of bleeding complications. Methods We studied 435 patients with atrial fibrillation who were hospitalized from 2000 to 2002 and given warfarin for prevention of thromboembolism. INR-specified rates for both ischemic and major hemorrhagic events were analyzed and the optimal levels of anticoagualtion in atrial fibrillation patients determined. Results The average dose of warfarin was (2.77±0.83) mg and the median duration of anticoagulation is 7 months (from 1 month to 3 years). In total,there were 31 confirmed bleeding events,with major hemorrhage occurring in 5 patients. Age of the patients in the hemorrhage group is not significantly higher than that in control group(65.09±9.99 vs 62.01±12.19, P =0.259). Chronic heart failure or hypertension increased the risk of bleeding during warfarin therapy. Multivariate analysis showed that INR≥3.0 is an independent risk factor for hemorrhage(OR=3.7435,95%CI 1.2819～8.9838). The risk of stroke or thromboembolism rose steeply with INR below 1.5. Conclusions To achieve optimal levels of anticoagulation with the lowest risk in patients with atrial fibrillation,values of INR below 1.5 and above 3.0 should be avoided.