亚洲人群心房颤动华法林抗凝治疗预防脑栓塞的最佳INR值

国内外大量的流行病学调查均显示心房颤动（房颤）的发病率呈明显升高趋势，华法林目前仍是治疗非瓣膜性心房颤动及预防脑栓塞的主要药物。欧美指南建议75岁以下房颤患者对血栓栓塞事件的一级预防及二级预防国际标准化比值（INR）应控制在2．0～3．0，75岁以上房颤患者的出血风险增加，INR应控制在1．6—2．6。亚洲人群华法林肝脏代谢酶活性与西方人群存在明显差异，且相关临床研究显示中等抗凝强度仍能取得与高抗凝强度相同的临床结局，因此华法林剂量应调低。国内初步研究显示，华法林抗凝治疗将INR控制在1．7-2．5范围内是安全有效的，其预防非瓣膜性房颤患者发生血栓栓塞事件的疗效明显优于阿司匹林，但仍需进一步大量临床试验及循证医学提供证据。

Optimal INR for treatment of asian population prescribed warfarin to prevent ischemic strokes

Epidemiological researches from our and foreign countries shown that the incidence of atrial fibrillation is significantly increased. Warfarin is still currently the main treatment of atrial fibrillation and taking precaution against cerebral infarction. The guidelines of western nations suggest that the INR controlled between 2.0 to 3.0 for primary and secondary prevention of thromboembolism events of atrial fibrillation patients. The risk of bleeding increases of the people who are 75 years older, therefore the INR should controlled between 1.6-2.6. The vitamin K epoxide reductase complex 1 of Asian population is greatly different from the Westerners＇, and clinical researches indicate that the re- sults of moderate anticoagulant intensity are as the same of high anticoagulant intensity, thus the dose of warfarin should lowered. Studies of China show that 1.7-2.5 is safe for warfarin of anticoagulant treatment. The effects of war- farin prior to aspirin for the treatment of prevent thromboembolism events, but further clinical trials and proof of evi- dence-based medicine are needed.