高龄患者心房颤动抗凝治疗临床观察

目的:探讨华法林在高龄心房颤动的临床抗凝治疗特点。方法:将120例患者随机分为三组,治疗组与观察组Ⅰ、观察组Ⅱ,其中治疗组60人,观察组Ⅰ、观察组Ⅱ每组30人。治疗组运用华法林治疗,观察组Ⅰ患者给予小剂量阿司匹林治疗,口服50 mg/d;观察组Ⅱ给予100 mg/d;随访6个月~1年,观察三组INR稳定值、华法林有效维持量以及出血和栓塞并发症发生率,并分析出血和血栓栓塞发生率与华法林的抗凝强度INR的关系。结果:治疗组与观察组Ⅰ、观察组Ⅱ在预防外周血栓栓塞和出血方面差异无统计学意义(P>0.05),治疗组与观察组Ⅰ、观察组Ⅱ在预防脑栓塞相比差异有统计学意义(P<0.05),治疗组疗效优于观察组Ⅰ、观察组Ⅱ.华法林的抗凝强度保持INR在2.1~2.9时要比华法林的抗凝强度需保持INR在1.0~2.0防治的栓塞率要低。结论:使用华法林时应严密监测INR使其小于3.0,同时在抗凝治疗过程中注意避免和纠正导致严重出血的诱因与疾病,此时华法林的抗凝强度对高龄房颤患者仍是安全的。

Effects of anticoagulant therapy in elderly patients with atrial fibrillation

Objective： To explore the use of warfarin as anticoagulation agent in elderly patients with atrial fibrillation.Methods： A total of 120 patients were randomly divided into treatment group（n=60 cases）,observation group Ⅰ（n=30 cases） and the observation group Ⅱ（n=30 cases）.The treatment group was treated with warfarin,while observation group Ⅰand Ⅱwas given 50 mg/d and 100 mg/d aspirin,respectively.Follow up was conducted for 6 months-1 year.Stable anticoagulation intensity（INR） values,the effective maintenance dose of warfarin,and the incidence of bleeding and embolic complications were observed,Relationship between the incidence of hemorrhage and thromboembolism and warfarin INR was analyzed.Results： Incidence of bleeding,hemorrhage or thromboembolism was not significant different among the three groups（P0.05）.Significant difference in cerebral embolism was observed between observation group ⅠⅡ（P0.05）.Therapeutic effects of the treatment group was better that that of the two observation groups.Warfarin INR between 2.1-2.9 showed better treatment effects in preventing thrombus than those with INR between 1.0～2.0.Conclusions： In case intensity of anticoagulation INR was controlled lower than 3,factors may inducing bleeding well monitored,Warfarin is safe in elderly patients with atrial fibrillation.