不同抗凝强度华法林抗凝治疗对老年阵发性心房颤动患者预后的影响

目的探讨应用拜阿司匹林及不同抗凝强度的华法林抗栓对老年阵发性心房颤动(paroxysmal atrial fibrillation,PAF)患者预后的影响。方法选择老年PAF患者663例,并随机单盲分为4组:A组154例(拜阿司匹林150 mg/d),B组132例华法林抗凝,国际标准化比值(INR)控制在1.2～1.6],C组197例(华法林抗凝,INR控制在1.7～2.5),D组180例(华法林抗凝,INR控制在2.6～3.0),随访近5年,记录4组终点事件及出血事件。结果与A组、B组比较,C组患者主要终点事件、次要终点事件、总主要事件、总事件所占的比例均明显下降(P<0.05,P<0.01);D组患者主要出血事件增加,总主要事件有所下降,但差异均无统计学意义(P>0.05)。结论老年PAF患者的抗凝治疗,华法林抗凝强度INR在1.7～2.5安全有效,而再增加抗凝强度并不增加获益,反而增加出血及其他事件发生率。

Antithrombotic effect of warfarin with different anticoagulation intensities on prognosis of old patients with PAF

Objective To explore the antithrombotic effect of aspirin and warfarin with different anticoagulation intensities on prognosis of old patients with paroxysmal atrial fibrillation(PAF). Methods 663 old PAF patients with medium or high stroke risk were randomly divided into four groups.The patients were treated with aspirin or warfarin with different anticoagulation intensities. Main end-point events,secondary end-point events,total main events,total bleeding events, and secondary bleeding events were observed and compared.Results Compared with the group receiving warfarin with anticoagulation intensity INR between 1.2-1.6 and the group receiving aspirin,the rates of main end-point events,secondary end-point events,total main events,total events were lower in the group receiving warfarin with anticoagulation intensity INR between 1.7-2.5(P<0.05).In the group receiving warfarin with anticoagulation intensity INR between 2.6-3.0,the bleeding events increased and total main events declined,but the differences had no statistical significance(P>0.05).Conclusions For old PAF patients with medium and high stroke risk,anticoagulation intensities of wafarin between INR 1.7-2.5 is safe and effective for Chinese,furthur increase in anticoagulation intensity of warfarin can not increase benefit,but increase bleeding events.