非瓣膜病心房颤动或心房扑动患者应用不同起始剂量华法林对INR达标速度的影响

目的观察我国非瓣膜病心房颤动（NVAF）或心房扑动（AFL）患者应用不同起始剂量华法林时，国际标准化比值（INR）首次达标和稳定的时间及出血并发症的发生率等，以进一步了解中国人应用国产华法林的最佳起始剂量。方法人选84例，随机分入起始剂量3．125mg组（第1组），起始5mg，2d后改为3．125mg组（第2组）和起始5mg治疗组（第3组）。于治疗第3、4、5、7、9天测定INR，根据INR调整华法林剂量，直到INR稳定于1．8～3．0，随访1个月。结果第3组比第1、2组提早达标并稳定，第1、2组差异无统计学意义。3组均无明显出血及血栓栓塞事件，INR增高发生率差异无统计学意义。结论对于中国NVAF或AFL患者，以5mg为初始剂量应用华法林能使INR安全、迅速、有效地达标并稳定。服药3次后即于第4天起测INR是安全的。

The effect of different initial warfarin dose on the target international normalized ratio in patients with nonvalvular atrial fibrillation or atrial flutter

Objective To investigate the effect of different initial warfarin dos on the target international normalized ratio(INR) and the safety during dose adjustment in patients with nonvalvular atrial fibrillation (NVAF) or atrial flutter(AFL). Methods Eighty-four patients with NVAF or AFL who had the indication of anticoagulation therapy were randomly assigned to three groups according to different initial warfarin dos,3. 125 mg/d ( Group 1 ), 3. 125 mg/d after 5 mg/d for tow days ( Group 2 ) and 5 mg/d ( Group 3 ). The INR was measured on the 3rd、4th、5th 、7th and 9th day. The dose of warfarin was adjusted according to INR, until INR was stabilized between 1.8 and 3.0 for at least one week at the same dose of warfarin. Results The mean time achieving and reaching a stabilized target INR in Group 3 was the shortest(P ＜ 0. 05 ) and the INR in Group 2 is shorter than Group1, but no significant difference (P ＞ 0. 05 ). There was no significant difference on the incidence of exorbitant INR in three groups. There were not thromboembolisms and important hemorrhage complications in all 3 groups. Conclusions In Chinese patients with NVAF or AFL who had the indication of anticoagulation therapy, an initial warfarin dosage of 5 mg/d treatment may reach the stabilized INR range quickly, safely and efficiently without increasing the bleeding complications. It' s not necessary to measure INR in the first 3 days.