不同抗凝强度华法林对虚证非瓣膜病性心房颤动患者的影响

目的探讨不同抗凝强度的华法林对虚证非瓣膜病性心房颤动患者抗栓治疗的疗效和安全性。方法选择80例口服华法林的中医辨证分型属虚证的患者,随机分为4个组,即国际标准化比值（INR）〈1.50、1.50~1.99、2.00~2.49、2.50~2.99组,每组20人,统计4组栓塞及出血事件。结果 INR〈1.50组栓塞事件较其他3组明显增多（P〈0.05）,2.50~2.99组出血事件较其他3组明显增多（P〈0.05）。结论口服华法林的虚证非瓣膜病性心房颤动患者将INR控制在1.50~2.49之间,能降低栓塞的发生率,同时不增加出血的发生率,具有较好疗效及安全性。

氟伐他汀对使用华法林抗凝治疗的房颤病人INR的影响

目的探讨氟伐他汀对使用华法林抗凝治疗的房颤病人华法林抗凝治疗国际标准化比值(INR)的影响。方法选择46例华法林抗凝治疗的房颤伴高胆固醇血症或冠心病的病人,随机分为:华法林治疗组(23例),维持原剂量华法林抗凝治疗;联合治疗组(23例),在常规治疗基础上加用氟伐他汀(来适可)40mg,睡前口服。治疗1周,测定并观察两组病人治疗前后INR的变化。结果联合治疗组INR较华法林治疗组明显增高(P<0.05)。结论氟伐他汀会增加华法林抗凝作用,治疗过程应注意监测INR,以调整华法林用量。

Thrombus precursor protein for monitoring anticoagulation in patients with mechanical valve prosthesis

Objective: To evaluate the plasma concentration of thrombus precursor protein (TPP) in patients after mechanical heart valve replacement, and to explore whether it can be used as a marker for monitoring anticoagulation. Methods: Totally 60 patients who took warfarin after mitral valve replacement and 20 control patients with non-valvular heart diseases were subjected in this study. Their plasma TPP concentration and international normalized ratio (INR) were determined, and compared not only between the anticoagulant patients and the control patients, but also between the patients with atrial fibrillaiton (AF, n=37) and the patients with sinus rhythm (SR, n=23) after mechanical valve replacement. The relationship between plasma TPP concentration and INR in the 60 anticoagulant patients was analyzed with linear regression. Results: It was found that the anticoagulant therapy effectively decreased plasma TPP concentration and elevated INR. In the anticoagulant group, the patients with AF had higher plasma TPP concentration than the others with sinus rhythm (P<0.05), although there was no significant difference in INR level between these 2 groups of patients (P>0.05). No significant correlation was found between plasma TPP concentration and INR in the anticoagulant patients (P>0.05). INR did not accord with plasma TPP concentration in several patients. Conclusion: INR can’t reflect the coagulation status and guide the anticoagulation correctly sometimes; TPP may be a valuable assistant marker for monitoring anticoagulation in patients with mechanical heart valve prothesis; Patients with AF may require higher density of anticoagulation and TPP is strongly suggested to be monitored in these patients.

Analysis and comparison of two low-dosage warfarin regimens in Chinese patients

Oral anticoagulation therapy with warfarin is used to prevent and treat venous and arterial thrombosis and embolism. Its narrow therapeutic index should be monitored carefully in order to reach the desired outcomes. The complexity of the pharmacokinetic and pharmacodynamics profile of warfarin makes it a challenge to use during treatment. Its manufacturing characteristics play a key role in its dosage. The aim of this study is to examine and evaluate the effect of two different warfarin regimens in Chinese patients. A cross-sectional study design was adopted. Medical records of all patients （n = 368） who received warfarin therapy in cardio-thoracic surgery wards between Sep. 2008 and Dec. 2009 were reviewed. Details of antithrombotic results of international normalized ratio （INR） monitoring were obtained. Statistical analysis was performed to assess factors predictive of INR therapeutic range at patients＇ discharge time according to different warfarin regimens （2.5 mg in China and 3.0 mg in USA）. The patients＇ mean age was （48.23~12.96） years. The percentage of patients within the INR therapeutic range in the group treated with 2.5 mg warfarin （35.17%） was much lower than that in group treated with 3.0 mg warfarin （47.72%）. Therefore, a significance difference was observed （P = 0.032〈0.05）. In this study, statistical values have shown that most of the patients were related to medical case requesting INR target range of 1.8-2.2 and 2.0-2.5, respectively. There was a statistically significant difference between the two groups. The study showed that the 2.5 mg-warfarin regimen was less suitable than the 3.0 mg-warfarin regimen. Medication regimen should be simplified as much as possible, especially during different treatment period.

基层医院心房纤颤患者华法林应用现状

目的：探讨基层医院当中采用华法林抗凝治疗方法应用于心房纤颤患者临床当中的现状,并针对结果进行分析,为改善华法林抗凝治疗的临床应用提供借鉴。方法：选取2010年5月至2012年10月期间收治的258例心房纤颤患者临床资料进行回顾分析,对所有患者采用电话随访的方式收集后续资料与数据。结果：258例心房纤颤患者当中有88例应用了华法林进行抗凝治疗,其中长期进行监测同时国际标准化比值（INR）达标人数为42人,占9.3%。在应用华法林进行抗凝治疗的88例患者当中,54例为住院患者,34例为门诊患者。结论：在基层医院的华法林应用当中,抗凝的知晓率、应用率均较低,治疗率、监测率以及达标率同样偏低。因此在临床当中应当加强医患双方对于华法林抗凝治疗效果的认识,同时需要了解抗凝治疗的必要性与重要性,通过健康宣教以及正确的临床管理,改善监测方式与华法林的使用现状,进而减少由心房纤颤所致的致残率与致死率。