摘要
目的观察不同强度华法林抗凝治疗对高龄稳定性冠心病合并非瓣膜性心房颤动患者的疗效和安全性。方法选择高龄稳定性冠心病合并非瓣膜性心房颤动患者91例,随机分为低强度组45例,华法林初始量为1.25mg/d,如国际标准化比值（INR）〈1.4,3-5d加0.5-1.0mg/d,INR维持1.4-2.0;中强度组46例,INR维持2.0-2.6。平均随访2年,比较2组主要终点（缺血性脑卒中、体循环栓塞）和次要终点（非致命性心肌梗死、全因死亡联合终点）及安全性终点（致命性出血、严重出血和轻度出血）。结果与中强度组比较,低强度组INR明显降低（1.70±0.36 vs 2.35±0.37,P=0.034）,华法林用量明显减少[（2.70±0.30）mg/d vs（3.50±0.35）mg/d,P=0.040]。中强度组安全性终点中的总出血事件比例明显高于低强度组（17.4%vs 4.4%,P=0.040）。结论高龄稳定性冠心病合并非瓣膜性心房颤动患者,华法林低强度与中强度抗凝治疗比较,预防缺血性心脑血管事件终点相似,但安全性甚好。
Objective To compare the effect and safety of different intensity warfarin anticoagulation therapy for elderly stable coronary heart disease（CHD）patients with atrial fibrillation（AF）.Methods Ninety-one elderly stable CHD patients with AF were randomly divided into mild intensity warfarin group（n=45）and moderate intensity warfarin group（n=46）.The patients were followed up for 2years,during which their primary endpoints（ischemic stroke and systemic embolism）,secondary endpoints（ischemic stroke,systemic embolism,non-fatal myocardial infarction,all causes of death）,and safety endpoints（fatal hemorrhage,severe hemorrhage,mild hemorrhage）were compared.Results The international normalized ratio and warfarin dosage were significantly lower in mild intensity warfarin group than in moderate intensity warfarin group（1.70±0.36 vs 2.35±0.37,P=0.034;2.70±0.30mg/d vs 3.50±0.35mg/d,P=0.040）.The incidence of total hemorrhage events at the safety endpoints was significantly higher in moderate intensity warfarin group than in mild intensity warfarin group（17.4%vs 4.4%,P=0.040）.Conclusion The effect of mild and moderate intensity warfarin anticoagulation therapy is similar in elderly stable CHD patients with AF.However,the safety of mild intensity warfarin anticoagulation therapy is higher than that of moderate intensity warfarin anticoagulation therapy.
出处
《中华老年心脑血管病杂志》
CAS
2016年第2期132-135,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
上海市卫生和计划委员会立项课题(20134374)
关键词
冠心病
心房颤动
华法林
抗凝药
出血
危险因素
coronary disease
atrial fibrillation
warfarin
anticoagulants
hemorrhage
risk factors
