高龄持续性心房纤颤患者不同剂量阿司匹林与华法林抗栓疗效及安全性比较

目的观察在持续性心房纤颤（房颤）的高龄患者中，不同剂量阿司匹林及华法林的疗效和安全性。方法选取年龄≥75岁的持续性房颤患者217例，分为4组，华法林高抗凝组『2．0〈国际标准化比率（international normalized ratio，INR）≤3．0154例，华法林低抗凝组（1．6≤INR≤2．0）53例，阿司匹林组（325mg／d）47例，阿司匹林组（200mg／d）63例，观察各组中血栓栓塞和出血事件的发生率。结果华法林高抗凝组与低抗凝组血栓栓塞发生率明显低于阿司匹林组（325mg／d），差异有统计学意义（矿=6．487，P=O．011；矿=7．929，P=O．005；r=6．354，P=O．012；r=7．771，P=O．005）；华法林高抗凝组出血发生率明显高于低抗凝组和阿司匹林组（200mg／d），差异有统计学意义（14.8％＇US．0m0，P〈0．05）；华法林高抗凝组与阿司匹林组（325mg／d）出血发生率比较，差异无统计学意义（P〉O．05）。结论对于年龄≥75岁的老年持续性房颤患者，低抗凝强度华法林（1．6≤INR≤2．0）安全有效，其疗效优于阿司匹林。

Comparison of antithrombotic efficacy and safety of different doses of warfarin and aspirin in elderly patients with persistent atrial fibrillation

Objectives To observe the efficacy and safety of different doses of warfarin and aspirin in elderly patients with persistent atrial fibrillation.Methods A total of 217 elderly patients aged≥75 with persistent atrial fibrillation were divided into 4 groups: 54 cases received high-intensity anticoagulation with warfarin [2.0< international normalized ratio(INR) ≤3.0],53 cases received low-intensity anticoagulation with warfarin(1.6≤INR≤2.0),47 cases received aspirin 325 mg/d,and 63 cases received aspirin 200 mg/d.The incidence rates of bleeding and thromboembolism events in these groups were observed.Results The incidence rates of thromboembolism events in high-and low-intensity anticoagulation with warfarin groups were significantly lower than those in patients received aspirin 325 mg/d(χ2=6.487,P=0.011;χ2=7.929,P=0.005;χ2=6.354,P=0.012;χ2=7.771,P=0.005).The incidence rate of bleeding events in patients received high-intensity anticoagulation with warfarin was significantly higher than those in patients received low-intensity anticoagulation with warfarin and aspirin 200 mg/d(14.8% vs.0 vs.0,P<0.05).There was no significant difference in incidence rate of bleeding events between patients received high-intensity anticoagulation with warfarin and patients received aspirin 325 mg/d(P>0.05).Conclusions The treatment of low-intensity anticoagulation with warfarin(1.6≤INR≤2.0) is possibly safe and effective in patients aged≥75 with persistent atrial fibrillation,which may be better than aspirin therapy.