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

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(P0.05)。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(P0.05)。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(P0.05)。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。

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

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.