Nonvalvular atrial fibrillation: evidence for a prothrombotic state

OBJECTIVE: To determine whether patients with nonvalvular atrial fibrillation (NVAF) have prothrombotic changes compared with patients in sinus rhythm. DESIGN: Cross-sectional study. Hemostatic function compared in NVAF patients without prior embolic event (transient ischemic attack or embolic stroke) and control subjects without prior thrombotic stroke, and in NVAF patients with prior embolic event and control subjects with prior thrombotic stroke. SETTING: Internal medicine outpatient group practice and anticoagulation clinic in 2 teaching hospitals. PATIENTS: A total of 75 NVAF patients (50 without and 25 with prior embolic event) and 42 control patients (31 without and 11 with prior thrombotic stroke) recruited concurrently over 18 months during 1990-91. OUTCOME MEASURES: Platelet count, prothrombin time (PT), partial thromboplastin time (PTT), and plasma levels of hemoglobin, fibrinogen, von Willebrand factor antigen, factor VIII, fibrin D-dimer, antithrombin III, protein C, protein S, fibrinopeptide A and prothrombin fragment F1+2. All statistical analyses were performed after adjustments for age and sex. RESULTS: The NVAF patients without a prior embolic event had significantly higher mean hemoglobin and fibrinogen levels (p < 0.001 and p = 0.05, respectively) than the control subjects without prior thrombotic stroke. The 29 NVAF patients not taking warfarin (none had had an embolic event) had significantly lower mean protein C and protein S levels (p = 0.012 and p < 0.001, respectively) and a significantly higher fibrinopeptide A level (p = 0.03, after exclusion of outliers) than the control subjects without prior stroke. The NVAF patients with a prior embolic event had alterations in the hemostatic variables similar to those seen in the control patients with a prior thrombotic stroke. The latter had significantly higher fibrinogen, von Willebrand factor antigen and factor VIII levels (p = 0.04, 0.002 and 0.002, respectively) and significantly lower protein S levels (p = 0.02) than the control subjects without prior stroke. CONCLUSIONS: NVAF patients without a history of an embolic event show evidence of a prothrombotic state compared with patients in sinus rhythm who have not had a thrombotic stroke. NVAF patients with a history of an embolic event show evidence of a prothrombotic state similar to that of patients in sinus rhythm who have had a thrombotic stroke. Prospective studies are needed to determine whether these abnormalities predict higher risk of stroke in individual NVAF patients.     

非瓣膜性心脏病心房颤动的抗凝治疗进展

非瓣膜性心脏病心房颤动(NVAF)是指风湿性心脏病以外的其他心脏病所致的心房颤动。随着社会的老龄化,NVAF逐年增多,栓塞和卒中的发生率也随之升高。其治疗主要存在三大难题:一是心房颤动复律与窦律的维持;二是心室律的有效控制,是对不能复律者的有效控制;三是防止发生卒中。本文就NVAF的流行病学特征、栓塞和卒中的危险因素,华法令在抗凝治疗中的临床应用、局限性、出血并发症及新型口服直接凝血酶抑制剂的出现和应用前景,中药在抑制血小板聚集、改善纤溶能力、减少或延缓血栓的形成中的抗凝治疗作用等问题进行综述。     

Anticoagulation control in atrial fibrillation patients present to outpatient clinic of cardiology versus anticoagulant clinics

Nonvalvular atrial fibrillation (NVAF) is the most common sustained cardiac arrhythmia in clinical practice, which if untreated results in a doubling of cardiovascular morbidity and mortality. AF is an independent predictor of stroke, with an annual risk 5 to 6 times higher than patients in sinus rhythm. During recent years,     

心房颤动患者血浆TAT水平变化对评价血栓栓塞危险性的临床价值

目的 :探讨心房纤颤 (AF)患者血液凝血系统分子标志物凝血酶 抗凝血酶Ⅲ (TAT)浓度变化及其对评价房颤患者血栓栓塞危险性的价值。方法 :45例慢性房颤患者中 9例通过经食道超声心动图 (TEE)检出左房血栓或有栓塞病史 ,为血栓阳性组 ,余 3 6例房颤患者为阴性组 ,另选临床情况相似的 2 1例窦律患者作为对照组 ,各组均分别采用酶联免疫双抗体夹心法 (ELISA)和发色底物法测定血浆TAT、D D浓度和AT Ⅲ活性 ,对其结果进行分析比较。结果 :AF患者无论是否伴有血栓 ,其TAT及D D含量均明显高于正常窦律组(P <0 0 5 ) ,AT Ⅲ活性明显低于正常窦律组 (P <0 0 5 )。血栓组患者TAT、D D水平较血栓阴性组明显升高(P均 <0 0 5 )。房颤患者TAT与D D水平呈正相关性 (rs=0 3 0 6,P <0 0 5 )。结论 :房颤患者可引起凝血系统的激活 ;检测房颤患者血浆中TAT可成为评估房颤患者血栓栓塞危险性的有价值的一种方法     

Anticoagulation therapy in Chinese patients with non-valvular atrial fibrillation: a prospective, multi-center, randomized,

Background  Non-valvular atrial fibrillation is associated with an increased risk of ischemic stroke; however, the appropriate intensity of anticoagulation therapy for Chinese patients has not been determined. The purpose of this study was to compare the safety and the efficacy of standard-intensity warfarin therapy, low-intensity warfarin therapy, and aspirin therapy for the prevention of ischemic events in Chinese patients with non-valvular atrial fibrillation (NVAF).

Methods  A total of 786 patients from 75 Chinese hospitals were enrolled in this study and randomized into three therapy groups: standard-intensity warfarin (international normalized ratio (INR) 2.1 to 2.5) group, low-intensity warfarin (INR 1.6 to 2.0) group and aspirin (200 mg per day) group. All patients were evaluated by physicians at 1, 3, 6, 9, 12, 15, 18, 21 and 24 months after randomization to obtain a patient questionnaire, physical examination and related laboratory tests.

Results  The annual event rates of ischemic stroke, transient ischemic attack (TIA) or systemic thromboembolism were 2.6%, 3.1% and 6.9% in the standard-intensity warfarin, low-intensity warfarin and aspirin groups, respectively (P=0.027). Thromboembolic event rates in both warfarin groups were significantly lower than that in the aspirin group (P=0.018, P=0.044), and there was no significant difference between the two warfarin groups. Severe hemorrhagic events occurred in 15 patients, 7 (2.6%) in the standard-intensity warfarin group, 7 (2.4%) in the low-intensity warfarin group and 1 (0.4%) in the aspirin group. The severe hemorrhagic event rates in the warfarin groups were higher than that in the aspirin group, but the difference did not reach statistical significance (P=0.101). The mild hemorrhagic and total hemorrhagic event rates in the warfarin groups (whether in the standard-intensity warfarin group or low-intensity warfarin group) were much higher than that in the aspirin group with the annual event rates of total hemorrhages of 10.2%, 7.6% and 2.2%, respectively, in the 3 groups (P=0.001). Furthermore, there was no significant difference in all cause mortality among the three study groups.

Conclusion  In Chinese patients with NVAF, the warfarin therapy (INR 1.6–2.5) for the prevention of thromboembolic events was superior to aspirin.

     

达比加群对非瓣膜性房颤卒中二级预防的疗效及安全性观察

目的：比较达比加群和华法林对非瓣膜性房颤卒中二级预防的疗效及安全性。方法：连续收集2013年1月1日至2015年1月28日在温州医科大学附属第一医院神经内科的非瓣膜性房颤伴缺血性卒中患者并根据其抗凝药物的不同分为达比加群组和华法林组,随访至2015年5月31日。纳入统计的有达比加群组78例,服用达比加群胶囊每日2次,每次110 mg;华法林组86例,服用华法林,维持监测国际标准化比值（INR）为2.0～3.0。比较2组血栓栓塞事件、出血事件的发生率。结果：华法林组发生血栓栓塞事件11例,达比加群组3例,2组比较差异有统计学意义（P＜0.05）;达比加群组消化道出血5例,颅内出血3例,华法林组消化道出血2例,颅内出血5例,2组比较差异无统计学意义（P＞0.05）;Has-bled评分是华法林严重出血的危险因素（P＜0.05）,不是达比加群的危险因素（P＞0.05）。结论：达比加群可以有效减少非瓣膜性房颤伴卒中患者再发血栓栓塞事件。同时,Has-bled评分不一定适用于评估服用达比加群进行二级预防抗凝的出血风险。     

Outcome of catheter ablation of atrial fibrillation in patients with prior ischemic stroke

Background Catheter ablation for atrial fibrillation (AF) has been demonstrated to be effective in a subsets of patients with AF.However,very few data are available in regard to patients with prior his...     

Atrial fibrillation

The incidence and prevalence of atrial fibrillation are increasing because of both population ageing and an age-adjusted increase in incidence of atrial fibrillation. Deciding between a rate control or rhythm control approach depends on patient age and comorbidities, symptoms and haemodynamic consequences of the arrhythmia, but either approach is acceptable. Digoxin is no longer a first-line drug for rate control: beta-blockers and verapamil and diltiazem control heart rate better during exercise. Anti-arrhythmic drugs have only a 40%-60% success rate of maintaining sinus rhythm at 1 year, and have significant side effects. The selection of optimal antithrombotic prophylaxis depends on the patient's risk of ischaemic stroke and the benefits and risks of long-term warfarin versus aspirin, but is independent of rate or rhythm control strategy. Ischaemic stroke risk is best estimated with the CHADS2 score (Congestive heart failure, Hypertension, Age > or = 75 years, Diabetes, 1 point each; prior Stroke or transient ischaemic attack, 2 points). For patients with valvular atrial fibrillation or a CHADS(2) score > or = 2, anticoagulation with warfarin is recommended (INR 2-3, higher for mechanical valves) unless contraindicated or annual major bleeding risk > 3%. Aspirin or warfarin may be used when the CHADS(2) score = 1. Aspirin, 81-325 mg daily, is recommended in patients with a CHADS(2) score of 0 or if warfarin is contraindicated. Stroke rate is similar for paroxysmal, persistent, and permanent atrial fibrillation, and probably for atrial flutter.     

老年非瓣膜性房颤脑卒中危险分层及抗凝现状分析

目的　对非瓣膜性房颤 (NVAF)脑卒中危险分层及基层医院抗凝现状分析。方法　选择NVAF住院患者 1 2 0例并分成ABC三组 ,分别统计脑卒中发生率 (五年 )。将治疗分a组 (未抗凝 ) ,b、c组 (阿司匹林抗血小板聚集 ) ,d组 (华法林抗凝 )。结果　 1 2 0例中A组脑卒中人数 1 3人 (59.1 % )。B组脑卒中人数 2 2人 (2 9.3 % )。C组 1人 (4.3 % )。A组与B组 ,B组与C组比较有明显差异 (P <0 .0 5)。d组脑卒中发生率为 0 ,明显优于a组。阿斯匹林≥ 1 50mg d(c组 ) ,脑卒中发生人数 3人 (1 2 .5 % ) ,与a组比有明显差异 (P <0 .0 5)。结论　A、B组脑卒中发生率明显高于C组 ,口服华法令及阿斯匹林可降低脑卒中发生率。基层医院对NVAF患者抗凝治疗不充分 ,脑卒中发生率高。     

低CHA2DS2-VASc评分的非瓣膜性心房颤动患者的心房血栓形成的独立危险因素

目的 探讨入院时低CHA2DS2-VASc评分（男性≤1分,女性≤2分）非瓣膜性心房颤动（NVAF）患者心房血栓形成的危险因素。方法 采用回顾性研究方法收集2009年6月~2019年2月在上海交通大学附属胸科医院行经食管超声心动图检查的NVAF患者临床资料（10 382例）。纳入48例伴有血栓的NVAF患者作为实验组,240例无血栓NVAF患者作为对照组。对两组的基线特征、临床生化指标和超声心动图进行单因素分析及多因素Logistic回归分析,对指标进行Pearson相关分析。结果 两组研究对象基线资料差异无统计学意义（P>0.05）。与对照组相比,伴有心房血栓患者的左心房内径增大（P<0.001）,肥厚型心肌病比例更多（P<0.001）,C反应蛋白（P<0.05）和尿酸（P<0.001）及红细胞分布宽度标准差（P<0.001）水平明显增高,差异均有统计学意义。其中左心房内径（P<0.001）、肥厚型心肌病（P<0.05）和C反应蛋白（P<0.05）是影响低评分患者心房血栓形成的独立影响因素。结论 左心房内径增大、肥厚性心肌病和C反应蛋白升高是低CHA2DS2-VASc评分的NVAF患者心房血栓形成的独立危险因素。临床中对合并上述危险因素的低评分NVAF患者应予积极抗凝,预防卒中发生。     

非瓣膜性心房颤动患者脑卒中危险因素的临床分析

目的回顾性分析非瓣膜性心房颤动患者发生脑卒中的危险因素。方法调查2002年6月至2003年9月在天坛医院住院的非瓣膜性心房颤动患者,通过比较心房颤动合并脑卒中与心房颤动无脑卒中患者的临床特征,筛选心房颤动发生脑卒中的危险因素。结果1)单因素危险因素分析中,与脑卒中相关的危险因素有:年龄>75岁、高血压病史、糖尿病病史、心力衰竭病史;年龄、血糖、血清总胆固醇、血压(收缩压和舒张压);左室收缩功能障碍[左室射血分数(EF)<50%]。2)多因素Logistic分析显示:年龄、高血压病史、左室收缩功能障碍(EF<50%)是脑卒中的独立危险因素。3)438例患者中66.5%接受了抗血栓治疗,其中抗血小板治疗占64.7%,长期抗凝治疗者仅1.8%。结论非瓣膜性心房颤动患者发生脑卒中的独立危险因素为年龄、高血压病史、左室收缩功能障碍(EF<50%)。     

Comparison of Aspirin and Naoxintong Capsule (脑心通胶囊) with Adjusted-Dose Warfarin in Elderly Patients with High-Risk of Non-Valvular Atrial Fibrillation and Genetic Variants of Vitamin K Epoxide Reductase

Objective: To compared the therapeutic effect of a Chinese patent medicine Naoxintong Capsule(脑心通胶囊, NXT) and aspirin with adjusted-dose warfarin in Chinese elderly patients(over 65 years) with nonvalvular atrial fibrillation(NVAF) and genetic variants of vitamin K epoxide reductase(VKORC1), who are at high-risk of thromboembolism. Methods: A total of 151 patients, with NVAF and AA genotype of VKORC1-1639(a sensitive genotype to warfarin) and a CHA2 DS2-VASc clinical risk score of 2 or above, were chosen for this study. Patients were randomized into two groups and orally treated with a combination of aspirin(100 mg/day) and NXT(1.6 g thrice a day) or adjusted-dose warfarin [international normalized ratio 2.0–3.0). The primary end points including ischemic stroke and death as well as the secondary end points including hemorrhage events were followed up for at least 1 year. Results: Baseline clinical data and the rates of primary end points were similar between groups. However, the rate of serious bleeding(secondary event) in the combination therapy group was lower than that in the adjusted-dose warfarin group(0% vs. 7.9%, odds ratio: 0.921, 95% confidence interval: 0.862–0.984, P=0.028). Conclusions: Aspirin combined with NXT and warfarin displayed comparable rates of primary end point including ischemic stroke and all-cause death during the 1-year follow-up. However, as compared with warfarin, the combination therapy reduced the rate of serious bleeding. Therefore, aspirin combined with NXT might provide an alternative pharmacotherapy in preventing ischemic stroke for elderly patients with NAVF who cannot tolerate warfarin.(No. ChiC TR-TRC-13003596)     

不同年龄段非瓣膜病心房纤颤的临床特点与预后分析

目的 了解各年龄段非瓣膜病心房纤颤(NVAF)患者的病因分布,脑卒中发生率以及心房纤颤类型对脑卒中的影响.方法 对329例NVAF患者进行随访调查.按年龄分为A组(≤60岁)、B组(61～70岁)、C组(71～80岁)、D组(>80岁)4组,调查各组的临床特点及预后.结果 NVAF各年龄组患者的首要病因均为冠心病;A、B组的甲状腺机能亢进性心脏病的病因构成均明显高于C、D组(P＜0.05).各年龄组患者的脑卒中发生率分别为21.79%、26.61%、35.85%和50.00%,脑卒中发生率有随年龄增长而增加的趋势(P＜0.05).对不同NVAF患者的缺血性脑卒中发生率按年龄因素进行分层分析,仅A组有统计学意义(P＜0.05).结论 冠心病是NVAF各年龄组的首要病因;脑卒中的发生随年龄的增加而增长;持续性和阵发性心房纤颤类型在年龄≤60岁的年龄组患者脑卒中发生率间有明显差异.     

口服胺碘酮转复持续性房颤的疗效

目的观察口服胺碘酮对反复发作和持续发作的持续性房颤的疗效与安全性。方法 (1)有症状持续性房颤患者 82例,予口服胺碘酮治疗,负荷量为3次／d,200 mg／次,连服1～4周后减至2次／d,200 mg／次,1-4周,维持量为每天 200 mg或100 mg。(2)比较43例复律患者与39例地高辛或倍他乐克控制室率患者心脑事件的发生率与死亡率。结果 (1)口服胺碘酮后43例复律,成功率52％。18例射血分数从(32±8)％上升至(46±10)％。左房内径从(4．6±1．1)cm缩小至(4．1±0．8)cm。除2例T4轻度升高、1例QT延长和心动过缓外,未发现明显副作用。(2)复律病人中仅1例半年后心衰恶化住院,而室率控制组1例脑栓塞、1例急性心肌梗死住院、1例心衰合并出血死亡。结论有症状、高危、有可能复律的持续房颤,不宜或不需电复律患者,应尽可能给予药物复律机会;药物复律应用胺碘酮是相对简便、安全且有效的。     

基层医院非瓣膜病性心房颤动患者抗凝治疗现状及华法林最佳初始剂量研究

目的: 了解基层医院非瓣膜病性心房颤动(NVAF)患者接受指南推荐的抗凝剂应用情况,探讨基层医院NVAF患者应用华法林抗凝治疗的最佳初始剂量。方法: 调查无抗凝治疗禁忌证的NVAF患者256例,分析华法林使用情况;将使用华法林的患者随机分为3.125 mg初始剂量组和5 mg初始剂量组,2组患者均根据国际标准化比值(INR)调整华法林剂量,直到INR稳定于2.0~3.0,随访2个月。结果: 256例患者中应用华法林者47例;高危患者164例,其中有29例应用华法林,高危患者中使用华法林的比率阵发性房颤(6.8%)低于持续性与持久性房颤(21.7%)(P < 0.05);3.125 mg组达稳定INR的时间与5mg组相似,3.125 mg组的INR增高发生率低于5 mg组(P < 0.05),2组均无明显出血及血栓事件。结论: 目前我国部分基层医院NVAF患者多数未接受指南推荐的抗凝剂,以3.125 mg为初始剂量应用华法林能使INR安全、迅速、有效的达标并稳定。     

A review of direct current cardioversions for atrial arrhythmia.

The risk of arterial embolism is well recognised following Direct Current Cardioversion (DCC) for atrial fibrillation although the use of prophylactic anticoagulation remains controversial. AIM: To determine the risk of arterial embolism post-cardioversion and which factors predict successful cardioversion and maintenance of sinus rhythm. MATERIALS AND METHODS: A retrospective study was carried out of all cardioversions performed for atrial fibrillation and atrial flutter at the Waveney Hospital Ballymena, during 1989-1993. A review of medical records and electrocardiograms was carried out to assess demographic characteristics, co-existent diseases, anticoagulant status, echocardiographic features and characteristics of the arrhythmia. Embolic events in the six weeks post-cardioversion were noted. RESULTS: The study included 157 cardioversions in 109 patients. The predominant arrhythmia was atrial fibrillation (n = 108, 69%). Three of 109 patients (2.7%) experienced embolic complications, none of whom had anticoagulation prior to the procedure. No risk factors for cerebro-vascular disease or significant valvular heart disease were present. Return to sinus rhythm was achieved in 143 (91%) procedures. Increasing coarseness of atrial fibrillation was associated with a non-significant trend towards successful restoration of sinus rhythm (p = 0.18). Recurrence of the original arrhythmia was predicted by an increase in coarseness of atrial fibrillation (p < 0.05). CONCLUSIONS: These findings indicate that embolic complications can occur in patients undergoing DCC with normal echocardiographic dimensions, and that prophylactic anticoagulation should be considered in all patients. Coarseness of atrial fibrillation may be used as a guide to predict the chance of successful cardioversion and of the likelihood of maintaining sinus rhythm once this has been achieved.     

血浆BNP水平在心房颤动复律前后的变化

目的 探讨BNP与心房颤动（AF）的关系。方法采用酶联免疫法（ELISA）检测30例房颤复律患者（A组）房颤发作时和房颤终止后5d及18例持续性房颤患者（B组）的血浆BNP水平。并与健康对照组（C组）进行比较。结果心房颤动组患者血浆BNP水平显著高于对照组（P〈0．01）；转复为窦性心律后其BNP水平明显下降（P〈0．01）。结论心房颤动影响血浆BNP水平的分泌，在转复为窦律后血浆BNP水平下降。     

心脏非瓣膜性房颤所致缺血性脑卒中的临床特点

目的 探讨心脏非瓣膜性心房颤动（NVAF）所致缺血性脑卒中的临床表现特点。方法 对110例NVAF所致的及400例无心房颤动的急性缺血性脑卒中病人的临床资料进行回顾性分析。结果 NVAF病人有以下临床特点：年龄偏大;病人瘫痪重,意识障碍程度深,偏盲发生率高而腔隙性脑梗死发生率低;病死率高。结论 NVAF引起的缺血性脑卒中病情重,病死率高。     

Association between use of amiodarone for non-valvular atrial fibrillation and patient survival: from the prospective China Atrial Fibrillation Registry

BackgroundPost hoc analysis of the landmark atrial fibrillation follow-up investigation of rhythm management trial revealed that amiodarone was associated with higher risks of mortality, intensive care unit admission, and non-cardiovascular death. We aim to evaluate the association between amiodarone use and patient survival under updated medical mode and level using data from the China Atrial Fibrillation (China-AF) Registry study.MethodsClinical data of 8161 non-valvular atrial fibrillation (NVAF) patients who were antiarrhythmic drug (AAD)-naive before enrollment into the China-AF Registry, recruited between August 2011 and February 2017, were collected. The primary outcome was all-cause mortality. A Cox proportional hazard regression model was used to evaluate the association between amiodarone use and the outcome. We also calculated the rate of sinus rhythm maintenance at the penultimate follow-up.ResultsCompared with 6167 patients of non-AAD group, 689 patients of the amiodarone group were younger (mean age 65.6 vs. 68.6 years), more frequently completed high school education, had fewer comorbidities such as chronic heart failure, prior bleeding, and stroke, and were more likely to be treated in tertiary hospitals while less hospitalization. The proportion of persistent AF was much lower among users of amiodarone, who were also less likely to be taking oral anticoagulants. The patients in the amiodarone group had a statistically insignificant lower incidence of all-cause mortality (2.44 vs. 3.91 per 100 person-years) over a mean follow-up duration of 300.6 ± 77.5 days. After adjusting for potential confounders, amiodarone use was not significantly associated with a lower risk of all-cause mortality (adjusted hazard ratio, 0.79; 95% confidence interval, 0.42–1.49). Sub-group analysis revealed the consistent results. The rate of sinus rhythm maintenance at the penultimate follow-up in the amiodarone group was significantly higher than in the non-AAD group.ConclusionsOur study indicated that amiodarone use was not significantly associated with a lower risk of 1-year all-cause mortality compared with a non-AAD strategy in “real-world” patients with NVAF.     

通心络胶囊联合阿司匹林预防非瓣膜病性心房颤动患者脑栓塞的对照研究

目的比较通心络胶囊联合阿司匹林、华法林和阿司匹林预防非瓣膜性心房颤动(NVAF)患者脑栓塞的疗效和不良反应。方法NVAF患者150例,其中通心络胶囊联合阿司匹林组50例,予通心络胶囊0.76g,3次/d,阿司匹林100mg/d;华法林组50例,予华法林1.25~5.0mg/d,维持国际标准化比值(INR)1.8~2.5;阿司匹林组50例,予阿司匹林100mg/d。所有患者均给予基础疾病治疗,随访2年,以脑栓塞发病率作为疗效判定依据。结果脑栓塞年发病率通心络胶囊联合阿司匹林组(6.0%)与华法林组(3.0%)比较差异无显著意义(P>0.05),阿司匹林组(15.0%)与通心络胶囊联合阿司匹林组比较差异有显著意义(P<0.05),华法林组与阿司匹林组比较差异有非常显著意义(P<0.01)。华法林组有1例出现脑出血,1例出现消化道出血;通心络胶囊联合阿司匹林组有6例出现上腹痛、恶心,2例出现牙龈肿痛;阿司匹林组有5例出现上腹痛、恶心。结论通心络胶囊联合阿司匹林预防NVAF患者脑栓塞的效果和华法林比较差异无显著意义,优于单用阿司匹林,无严重不良反应发生,且不需检测凝血酶原时间(PT)和INR。不愿意接受华法林治疗的NVAF患者可给予通心络胶囊联合阿司匹林预防脑栓塞并发症。