摘要
对2014年4月至2016年8月徐州医学院第二附属医院神经内科住院及门诊治疗72例伴非瓣膜病心房颤动（NVAF）青年缺血性脑卒中患者，分别行华法林（36例，华法林组）和达比加群（36例，达比加群组）治疗，患者年龄18～45岁，有3种以上血管疾病危险因素者50例（69％）。口服华法林从小剂量开始，维持国际标准化比值（INR）为2．0—3．0；口服达比加群酯每次110mg、2次／d。治疗后1年，华法林和达比加群组停药者分别为10例（28％）和2例（6％），发生血栓栓塞事件分别为8例（22％）和1例（3％），两组差异均有统计学意义（P=0．02，P=0．03）；华法林组监测INR共记录233个INR值，平均INR值为2．3，平均INR在治疗范围内的时间百分比为75％（174／233）；华法林组发生2例死亡事件，达比加群组无死亡事件；华法林和达比加群组出现不良反应者分别为19例[53％；总出血事件9例（25％，轻微出血6例、严重出血3例），恶心呕吐5例，便秘腹泻2例，头晕头痛3例]和6例[17％；总出血事件2例（6％，均为轻微出血），恶心呕吐2例，便秘腹泻2例]，两组差异有统计学意义（χ^2=13．3，P〈0．01）。提示达比加群酯治疗伴NVAF的青年缺血性脑卒中患者有效性优于华法林，安全性更高。
Seventy two ischemic stroke patients aged 18 -45 years with nonvalvular atrial fibrillation treated in the Second Affiliated Hospital of Xuzhou Medical College from April 2014 to August 2016 were assigned to warfarin group （ n = 36） and dabigatran group （ n =36 ）. In warfarin group the oral warfarin started from small dose and maintained international normalized ratio （INR） as 2.0 to 3.0. In dabigatran group 110 mg dabigatran etexilate was given b. i. d. All patients were followed up for one year after treatment. Medication was discontinued in 10 cases （28%） of warfarin group and 2 cases （6%） of dabigatran group one year after treatment （P=0.02）. There were 8 （22%） cases of thromboembolic events in warfarin group and 1 （3%） case in dabigatran group （P =0.03）. In warfarin group 233 INR values were recorded with an average of 2.32, and the percentage of time in therapeutic range （TTR） was 75% （ 174/ 233）. There were 2 deaths in warfarin group and no death in dabiga group. There were 19 （53%） cases of adverse reactions in warfarin group, including 9 cases of bleeding （6 mild bleeding and 3 serious bleeding）, 5 cases of nausea and vomiting, 2 cases constipation or diarrhea, 3 cases of headache and dizziness. There were 6 （ 17% ） cases of adverse reactions in dabigatran group, including 2 cases of mild bleeding, 2 cases of nausea and vomiting, 2 cases of constipation or diarrhea. There was significant difference in the incidence of adverse reactions between the two groups（χ^2 = 13.3 ,P 〈0.01 ）. The results indicate that the efficacy and safety of dabigatran is superior to that of warfarin for young ischemic stroke patients with nonvalvular atrial fibrillation.
作者
王凯
魏秀娥
荣良群
肖利杰
刘腾飞
Wang Kai Wei Xiu＇e Rong Liangqun Xiao Lijie Liu Tengfei(Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical College, Xuzhou 221006, Jiangsu, China)
出处
《中华全科医师杂志》
2017年第10期796-799,共4页
Chinese Journal of General Practitioners
基金
徐州矿务集团有限公司科技项目（2014-59）
