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目的:探讨华法林在慢性心房颤动(CAf)抗凝治疗中的合理应用。方法:共入选234例具有血栓栓塞高风险的CAf患者,给予华法林抗疑治疗,监测国际标准化比值(INR)以调整华法林用量,随访观察华法林的不同起始剂量、不同的抗凝强度以及高龄(≥65岁)等因素对INR达标时间、INR稳定值、华法林维持量、出血率及栓塞率的影响。结果:分别采用开始剂量为普通剂量(2．5mg／d)与小剂量(1．25 mg／d)2种方式,两者最终获得稳定的INR、华法林维持量及出血率均差异无统计学意义,但前者能明显缩短INR首次达标时间及获得INR 稳定值的时间(均P<0．01),并有降低栓塞率的趋势;与低强度抗凝相比,中强度抗凝能显著降低栓塞率(P< 0．05),虽然伴出血率明显升高(P<0．05),但无严重出血发生;在相同的目标INR内,高龄患者出血率并不增加,但所需的华法林维持量有所降低(P<0．01)。结论:以普通量的华法林开始CAf抗凝治疗是安全的,抗栓塞效果优于小剂量;对具有栓塞高风险的CAf需保持中强度抗凝水平;华法林抗凝治疗并不增加高龄患者的出血风险。
Objective: To investigate the reasonable application of warfarin in anticoagulant therapy of chronic atrial fibrillation (CAf). METHODS: A total of 234 CAf patients at high risk of thromboembolism were enrolled. Warfarin was given anti-susceptive therapy. The international normalized ratio (INR) was monitored to adjust the warfarin dosage. The initial doses of warfarin were followed up. Different doses of warfarin Anticoagulant strength and elder age (≥65 years) and other factors on INR compliance time, INR stability, warfarin maintenance, bleeding rate and embolization rate. Results: Two kinds of methods were used: normal dose (2.5mg / d) and low dose (1.25mg / d), respectively. The final INR was stable, and the difference between warfarin maintenance and hemorrhage rate However, the former significantly shortened the time when INR was first achieved and INR was stable (both P <0.01), and had a tendency to reduce the rate of embolization. Compared with low-intensity anticoagulation, moderate-intensity anticoagulation (P <0.05). Although the hemorrhage rate was significantly increased (P <0.05), no severe bleeding occurred. In the same target INR, the bleeding rate did not increase in elderly patients, Warfarin maintenance required decreased (P <0.01). CONCLUSIONS: Anticoagulation with CAf anticoagulation is warranted with a normal amount of warfarin and is superior to low-dose antithrombotic therapy; moderate-intensity anticoagulation is required for CAf with a high risk of embolization; anticoagulation with warfarin does not increase elderly patients The risk of bleeding.