华法林对中国人心房颤动患者抗栓的安全性和有效性研究

目的　通过回顾性分析心房颤动 (房颤 )患者的抗栓治疗 ,初步探讨中国人华法林国际标准化率 (INR)的合理范围。方法　调查 4 35例房颤患者应用华法林抗凝及INR监测情况 ,分析出血和血栓栓塞事件的危险因素及与INR的关系。结果　华法林疗程时间中位数 7个月 ,平均剂量为(2 77± 0 83)mg。共发生出血事件 31例 (7 11% ) ,其中严重出血 5例 ,轻微出血 2 6例。发生出血患者年龄略高于对照组 (6 5 1± 10 0 )岁与 (6 2 0± 12 2岁 ) ],但差异无统计学意义 (P =0 2 5 9) ;出血患者血压高于对照组 ,合并心力衰竭较多 (P =0 0 5 )。多因素分析中INR≥ 3为预测出血的独立危险因素 (OR =3 74 )。血栓栓塞事件 37(17 4 7% )例 ,发生缺血性卒中或栓塞的危险随INR下降明显增加。结论　房颤患者华法林抗凝目标INR值应避免低于 1 5或高于 3 0。

The efficiency and safety of anticoagulation therapy in atrial fibrillation in Chinese

OBJECTIVE: To determine the strength of oral anticoagulation therapy in atrial fibrillation that provides the best balance between the prevention of thromboembolism and the occurrence of bleeding complications. METHODS: We studied 435 patients with atrial fibrillation who were hospitalized from 2000 to 2002 and given warfarin for prevention of thromboembolism. INR-specified rates for both ischemic and major hemorrhagic events were analyzed and the optimal levels of anticoagulation in atrial fibrillation patients determined. RESULTS: The average dose of warfarin was (2.77 +/- 0.83) mg and the median duration of anticoagulation is 7 months (from 1 month to 3 years). In total, there were 31 confirmed bleeding events, with major hemorrhage occurring in 5 patients. Age of the patients in the hemorrhage group is not significantly higher than that in control group (65.09 +/- 9.99 vs 62.01 +/- 12.19, P = 0.259). Chronic heart failure or hypertension increased the risk of bleeding during warfarin therapy. Multivariate analysis showed that INR >or= 3.0 is an independent risk factor for hemorrhage (OR = 3.7435, 95% CI 1.2819 - 8.9838). The risk of stroke or thromboembolism rose steeply with INR below 1.5. CONCLUSIONS: To achieve optimal levels of anticoagulation with the lowest risk in patients with atrial fibrillation, values of INR below 1.5 and above 3.0 should be avoided.