学术论文

      高龄非瓣膜病性房颤患者长期应用华法林抗凝治疗的疗效与安全性

      Efficacy and safety of warfarin in long-time anticoagulation treatment in elderly patients with nonvalvular atrial fibrillation

      摘要:
      目的:观察高龄非瓣膜病性房颤(NVAF)患者长期应用华法林抗凝治疗的疗效及安全性。方法入选NVAF患者按年龄分为3组,高龄老年组55例,年龄≥80岁(INR在1.6~2.5之间);老年组45例,年龄65~79岁(INR在l.6~2.5之间);中年组37例,年龄<65岁(INR在2.0~3.0)。入选患者长期服用华法林抗凝治疗,根据INR测定值及其变化趋势来调整华法林剂量,使INR达标,比较3组患者口服华法林5年时的不良反应及华法林的安全用药范围及国际标准化比值(INR)。结果5年随访期间,三组患者均未发生缺血性卒中,三组患者出血及其他不良反应无统计学差异(P>0.05)。随访第5年时,高龄老年组华法林组剂量(2.89±0.52)mg,INR(2.15±0.31),老年华法林组剂量(2.99±0.41)mg,INR (2.21±0.30),差异无统计学意义(P>0.05)。中年组华法林剂量(3.39±0.61)mg,INR(2.55±0.60),华法林剂量及INR明显高于高龄老年组和老年组,差异有统计学意义(P<0.05)。结论严密监测INR下,对于高龄老年NVAF患者应用华法林抗凝治疗,INR控制在1.5~2.5安全有效。
      Abstract:
      Objective To observe the efficacy and safety of warfarin in long-time anticoagulation treatment in elderly patients with nonvalvular atrial fibrillation (NVAF).Methods NVAF patients were divided into 3 groups according to their ages: advanced elderly group [n=55, age≥80, and international normalized ratio (INR) controlled from l.6 to 2.5], elderly group (n=45, aged from 65 to 79, and INR controlled from l.6 to 2.5) and middle-aged group (n=37, age<65, and INR controlled from 2.0 to 3.0). All enclosed patients were given warfarin for anticoagulation treatment for a long time, and the dosage of warfarin was adjusted according to INR detection values and change trends. The adverse reactions, safe range and INR of warfarin for 5 y were compared in 3 groups.Results During 5-year follow-up period, there was no ischemia stroke observed, and there was no statistical difference in bleeding and other adverse reactions in 3 groups (P>0.05). On the 5th year, dosage of warfarin was (2.89±0.52) mg and INR was (2.15±0.31) in advanced elderly group, and (2.99±0.41) mg and (2.21±0.30) in elderly group without statistical difference (P>0.05). In middle-aged group, the dosage of warfarin was (3.39±0.61) mg and INR was (2.55±0.60), which was significantly higher than those in advanced elderly group and elderly group (P<0.05). Conclusion When warfarin is used for anticoagulation treatment effectively and safely in elderly patients with NVAF, INR should be closely monitored and controlled from 1.5 to 2.5.
      作者: 胡广卉 [1] 武云涛 [2] 陈艳梅 [3] 赵保钢 [4] 高迎春 [5] 朱润秀 [6]
      Author: HU Guang-hui [1] WU Yun-tao [2] CHEN Yan-mei [3] ZHAO Bao-gang [4] GAO Ying-chun [5] ZHU Run-xiu [6]
      作者单位: 北京市大兴区人民医院药剂科, 北京,102600 北京军区总医院干四科 北京军区总医院 干一科 北京市大兴区人民医院 脑外科, 北京,102600 内蒙古自治区人民医院心内科 内蒙古自治区人民医院 神经内科
      年,卷(期): 2014, (6)
      分类号: R541.75
      机标分类号: R54 R9
      在线出版日期: 2015年1月23日