华法林低强度抗凝治疗高龄非瓣膜病性心房颤动长期随访研究

摘要

Objective To observe the curative effect and safety of low-intensive warfarin anticoagulation therapy for a long time in elderly patients with non-valvular atrial fibrillation (NVAF).Methods NVAF patients (n=115, male 93 and female 22) were chosen from the Chinese PLA Army General Hospital from Jan. 2007 to Jun. 2009. All patients were divided, according to age, into very elderly group (n=58, age≥80) and elderly group (n=57, aged from 65 to 79). The patients were given the examinations of blood routine, liver and kidney functions, thrombin function and international normalized ratio (INR), and oral warfarin in predose (2.5 mg/d) for low-intensive anticoagulation. The target was that INR was from l.6 to 2.5 and dose of warfarin was regulated according to doses of warfarin. The dose of warfarin accorded with target INR steady and adverse reactions were recorded after follow-up for 5 y.Results After continuous monitoring for 5 y, the difference in doses of warfarin accorded with target INR steady had no statistical significance between 2 groups (P>0.05). The difference in INR had no statistical significance between 2 groups (P>0.05). There was no acute cerebral infarction onset in all patients. The difference in incidence of adverse reactions (17.2%vs. 12.3%) had no statistical significance between 2 groups (P>0.05). Conclusion When INR is comprehensively monitored and controlled from 1.6 to 2.5, warfarin is safe and effective for anticoagulation in elderly patients with NVAF.%目的 观察长期应用华法林低强度抗凝治疗高龄非瓣膜病性心房颤动(NVAF)患者的疗效及安全性.方法 入选2007年1月~2009年6月期间于陆军总医院治疗的NVAF患者115例,其中男性93例,女性22例.所有患者依据年龄分为高龄老年组(58例,≥80岁)和老年组(57例,65~79岁).所有患者用药前查血常规、肝肾功能、凝血功能、国际标准化比值(INR)等,均口服华法林,初始剂量为2.5 mg/d,采用低强度抗凝,目标INR l.6~2.5,依据INR调整华法林剂量.随访5年,记录达到目标INR的华法林用量和药物的不良反应情况.结果 连续监测5年,两组患者达到目标INR稳态的华法林用量比较,差异无统计学意义(P>0.05).两组INR比较,差异无统计学意义(P>0.05).所有患者均无急性脑梗死发生.两组不良反应发生率比较(17.2%vs.12.3%),差异无统计学意义(P>0.05).结论 严密监测国际标准化比值下,高龄老年NVAF患者应用华法林抗凝治疗,国际标准化比值控制在1.6~2.5是安全有效的.