老年心房颤动患者华法林长期抗凝治疗的效果与安全性

摘要

ABSTRACT:Objective To evaluate the efficacy and safety of long-term anticoagulation therapy with warfarin in elderly patients with atrial fibrillation and the sustaining dosage of warfarin,and to provide empirical dose of warfarin during the course of long-term anticoagulation.Methods Fifty-two elderly patients with atrial fibrillation whose anticoagulation duration exceeded 1 2 months were included into this study, all the patients suffered from atrial fibrillation for more than 1 2 months,and the hemorrhage event,stroke event and the sustaining dosage of warfarin in each patient were determined by the follow-up record.Results Thirty male patients and twenty-two female patients averaged age (72.45 ± 5.56)years old were diagnosed as permanent atrial fibrillation by electrocardiography,the average duration of follow-up was (23.20±11.35)months.No fatal hemorrhage event such as cerebral hemorrhage was found during the course of long-term anticoagulation,mild hemorrhage was found in 10 patients,including 2 patients with gingiva hemorrhage,1 patient with epistaxis,2 patients with hemoptysis,2 patients with ecchymosis in the left leg and the other 3 patients with conjunctiva hemorrhage.After adjusting the dosage of warfarin,all the hemorrhage symptom disappeared.Stroke event emerged in 1 patient and the incidence was 1 .9%.No change was found in the sustaining dosage of warfarin during the course of long-term anticoagulation and the average dosage of warfarin was about 3.6 mg/d when giving sufficient anticoagulation therapy.Conclusion Long-term anticoagulation therapy with warfarin in the elderly patients with AF is safe and efficacious and the sustaining dosage of warfarin is about 3 .6 mg/d .%目的：探讨老年心房颤动（房颤）患者华法林长期抗凝治疗的疗效、安全性和华法林剂量的动态变化，为经验性抗凝治疗提供依据。方法选取心血管专科门诊每月进行规律随访的抗凝治疗时间＞12个月、年龄≥65岁的持续性房颤患者52例，根据随访记录统计患者出血、脑梗死的情况以及华法林的用药剂量。结果经心电图确诊的持续性房颤患者52例，其中男30例，女22例，平均年龄（72．5±5．6）岁，平均随访时间（23．20±11．35）个月；在随访期间，未出现颅内出血等严重威胁生命的出血，轻度出血10例，其中牙龈出血2例、鼻出血1例、咯血2例、结膜出血3例和双下肢皮肤瘀斑 2例；52例患者出现脑梗死 1例（1．9％）；在长达24个月的随访时间中，房颤患者华法林抗凝治疗的剂量无显著变化，达到充分抗凝的平均剂量为3．6 mg／d左右。结论房颤患者长期抗凝治疗安全有效，其平均维持剂量约为3．6 mg／d，但需要规律检测国际标准化比值。