Objective: To study the current status of anti-coagulation treatment by guideline and the best initial warfa rin dose in patients with nonvalvular atrial fibrillation (NVAF) in primary hospital. Methods: Two hundred and fifty-six patients without contraindication to anti-coagulation therapy were enrolled into this study. The status of using warfarin were registered and analyzed.Patients with NVAF who used warfain to anti-coagulation treatment were randomly assigned to two groups according to different initial dose ,3. 125 mg and 5 mg. The dose of warfarin was adjusted according to international normalized ratio( INR), until INR was stabilized between 2.0 and 3.0 for at least 2 months at the same dose of warfarin. Results: Among two hundred and fifty-six cases with NVAF,only 47 cases ( 18.4 ％ ) were given anti-coagulation treatment by guideline. Of the total 164 cases (64.1％ ) of high risk group, 29 cases (17.7％) were given warfarin. Among 164 patients of high risk group, the ratio of warfarin used in paroxysmal atrial fibrillation was significant lower than persistent atrial fibrillation and long standing atrial fibtillation ( P ＜ 0. 05 ). Treatment decision-making of physicians and patients factors were associated with low rates of warfarin used. The mean time achieving a stabilized target INR in two groups was significant(P ＞ 0.05 ). The incidence of exorbitant INR was shorter than that in the 5 mg group ( P ＜ 0.05 ). There was no significant difference in thromboembolisms and important hemorrhage complications in two groups( P ＞ 0.05 ). Conclusions:Most of the patients with NVAF did not receive appropriate antithrombotic therapy in primary hospital. An initial warfarin dose of 3. 125 mg treatment may reach the stabilized INR range quickly, safely and efficiently without increasing the bleeding complications.%目的:了解基层医院非瓣膜病性心房颤动(NVAF)患者接受指南推荐的抗凝剂应用情况,探讨基层医院NVAF患者应用华法林抗凝治疗的最佳初始剂量.方法:调查无抗凝治疗禁忌证的NVAF患者256例,分析华法林使用情况;将使用华法林的患者随机分为3.125 mg初始剂量组和5 mg初始剂量组,2组患者均根据国际标准化比值(INR)调整华法林剂量,直到INR稳定于2.0～3.0,随访2个月.结果:256例患者中应用华法林者47例;高危患者164例,其中有29例应用华法林,高危患者中使用华法林的比率阵发性房颤(6.8%)低于持续性与持久性房颤(21.7%)(P＜0.05);3.125 mg组达稳定INR的时间与5 mg组相似,3.125 mg组的INR增高发生率低于5 mg组(P＜0.05),2组均无明显出血及血栓事件.结论:目前我国部分基层医院NVAF患者多数未接受指南推荐的抗凝剂,以3.125 mg为初始剂量应用华法林能使INR安全、迅速、有效的达标并稳定.
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