International normalized ratio control and subsequent clinical outcomes in patients with atrial fibrillation using warfarin

Journal of Thrombosis and Thrombolysis - We explored associations between INR measures and clinical outcomes in patients with AF using warfarin, and whether INR history predicted future INR...     

低强度抗凝合用洛伐他汀预防房颤患者脑卒中的研究

目的前瞻性研究低强度华法林抗凝合用洛伐他汀对非瓣膜性心房颤动患者脑卒中的预防作用。方法将自愿接受脑卒中预防的628例非瓣膜性心房颤动患者随机分为实验组和对照组各314例。对照组维持目标抗凝强度凝血活酶臣际标准化比率（INR）2．0～3．0;实验组维持目标抗凝强度INR1．5～1．9．并加用洛伐他汀20mg／d,随访7～56个月。结果与对照组比较,实验组出血事件和缺血性卒中的发生率明显降低．5a生存率明显提高。结论低强度华法林抗凝合用洛伐他汀能有效降低非瓣膜性心房颤动患者脑卒中发生率,降低华法林抗凝引起出血的危险性,提高长期生存率。     

老年心房颤动患者的华法林抗凝治疗

脑卒中是严重威胁我国老年人群健康的主要疾病之一,规范的抗凝治疗可以显著减少与心房颤动(房颤)相关的心源性脑卒中的发生率。现对老年房颤患者的华法林抗凝治疗的有关问题作一阐述。1老年房颤的流行病学房颤是最常见的心律失常。在美国,约有230万房颤患者,每年因房颤住院的患     

华法令在慢性房颤患者中的应用研究

目的分析慢性心房颤动(AF)患者的抗凝治疗状况与未抗凝的原因以及华法令预防血栓栓塞的疗效和安全性。方法收集198例慢性房颤患者与抗凝有关的病历资料进行分析,并根据应用抗凝药物不同分为:华法令组(53例)、阿司匹林[300mg/d,33例]和阿司匹林[(100～150)mg/d,45例]3组进行对比。结果①144例(72.7%)伴有血栓栓塞高危因素,53例(36.8%)采用了华法令抗凝,78例(54.2%)予以阿司匹林抗栓。②91例(63.2%)未用华法令原因:53.8%为医生指导问题,33.0%为患者问题。③三组比较仅见华法令组与阿司匹林(100～150mg/d)两组间栓塞发生率差异具有统计学意义(P<0.01),均未见明显不良反应发生。结论①房颤患者中华法令应用不足,加强医生常见相关知识,积累华法令应用经验,对患者进行脑卒中预防常识的普及,有助于提高华法令的正确使用率。②华法令疗效肯定、用药安全、副作用少,应根据危险分层权衡栓塞和出血的利弊,使大多数卒中高危的房颤患者能从合理的抗凝治疗中获益。     

华法林对老年持续性房颤患者的疗效

目的:探讨华法林对老年房颤(AF)患者的疗效和安全性。方法:选择2014年1月至2016年12月于我院治疗的老年AF患者100例。按照随机对照原则,患者被分为华法林组(51例)和阿司匹林组(49例),两组均随访治疗1年。观察比较两组终点事件发生率和不良反应发生率。结果:阿司匹林组失访1例。终点事件:华法林组:脑梗死2例;阿司匹林组:脑梗死7例、外周血管栓塞2例、死亡1例。华法林组终点事件总发生率显著低于阿司匹林组(3.92%比20.83%,P=0.010)。不良反应:华法林组:皮肤瘀斑3例、牙龈出血1例;阿司匹林组:黑便3例,两组总不良反应发生率无显著差异(P=0.934)。结论:华法林能显著降低老年AF患者终点事件的发生率,值得推广应用。     

Closure of a patent arterial duct in a septuagenarian with atrial fibrillation

We occluded a large arterial duct in a patient with atrial fibrillation, using an Amplatzer duct occluder, with no residual shunt at the end of the procedure. Follow-up revealed recanalization, which was successfully treated with a 4 mm Amplatzer ASD occluder. It is speculated the reopening of the initially occluded duct was the consequence of anticoagulation needed because of the atrial fibrillation.     

华法林在慢性心房颤动抗凝治疗中的应用

目的:探讨华法林在慢性心房颤动(CAf)抗凝治疗中的合理应用。方法:共入选234例具有血栓栓塞高风险的CAf患者,给予华法林抗疑治疗,监测国际标准化比值(INR)以调整华法林用量,随访观察华法林的不同起始剂量、不同的抗凝强度以及高龄(≥65岁)等因素对INR达标时间、INR稳定值、华法林维持量、出血率及栓塞率的影响。结果:分别采用开始剂量为普通剂量(2．5mg／d)与小剂量(1．25 mg／d)2种方式,两者最终获得稳定的INR、华法林维持量及出血率均差异无统计学意义,但前者能明显缩短INR首次达标时间及获得INR 稳定值的时间(均P<0．01),并有降低栓塞率的趋势;与低强度抗凝相比,中强度抗凝能显著降低栓塞率(P< 0．05),虽然伴出血率明显升高(P<0．05),但无严重出血发生;在相同的目标INR内,高龄患者出血率并不增加,但所需的华法林维持量有所降低(P<0．01)。结论:以普通量的华法林开始CAf抗凝治疗是安全的,抗栓塞效果优于小剂量;对具有栓塞高风险的CAf需保持中强度抗凝水平;华法林抗凝治疗并不增加高龄患者的出血风险。     

Failure to prescribe warfarin to patients with nonrheumatic atrial fibrillation

OBJECTIVE: To determine how often warfarin was prescribed to patients with nonrheumatic atrial fibrillation in our community in 1992 when randomized trials had demonstrated that warfarin could prevent stroke with little increase in the rate of hemorrhage, and to determine whether warfarin was prescribed less frequently to older patients—the patients at highest risk of stroke but of most concern to physicians in terms of the safety of warfarin. DESIGN: Cross-sectional study. Appropriateness of warfarin was classified for each patient based on the independent judgments of three physicians applying relevant evidence and guidelines. SETTING: Two teaching hospitals and five community-based practices. PATIENTS: Consecutive patients with nonrheumatic atrial fibrillation (n=189). MEASUREMENTS AND MAIN RESULTS: Warfarin was prescribed to 44 (23%) of the 189 patients. Warfarin was judged appropriate in 98 patients (52%), of whom 36 (37%) were prescribed warfarin. Warfarin was prescribed to 11 (14%) of 76 patients aged 75 years or older with hypertension, diabetes mellitus, or past stroke, the group at highest risk of stroke. In a multivariable logistic regression model controlling for appropriateness of warfarin and other patient characteristics, patients aged 75 years or older were less likely than younger patients to be treated with warfarin (odds ratio 0.25; 95% confidence interval 0.10, 0.65). CONCLUSIONS: Warfarin was prescribed infrequently to these patients with nonrheumatic atrial fibrillation, especially the older patients and even the patients for whom warfarin was judged appropriate. These findings indicate a substantialopportunity to prevent stroke. Dr. Antani performed this work as a medical student at Case Western Reserve University. Dr. Landefeld is a Senior Research Associate, Health Services Research and Development Service, Department of Veterans Affairs. Dr. Beyth is a Merck/AFAR Fellow in Geriatric Clinical Pharmacology. Dr. Covinsky is an awardee of the Research and Development Core, Claude D. Pepper Older Americans Independence Center, Case Western Reserve University. Supported by an American College of Physicians’ George Morris Piersol Teaching and Research Scholarship (CSL), a John A. Hartford Foundation/American Federation for Aging Research Geriatric Pharmacology Scholarship (MRA), and by grants from the John A. Hartford Foundation (92307-G and the Case Western Reserve University Geriatric Recruitment Initiative) and the National Institutes of Health (RO1 AG09657-01 and P60 AG10418-03).     

非瓣膜性房颤患者华法林抗凝治疗现况研究

目的探讨非瓣膜性心房颤动患者规范化使用华法林抗凝治疗的现状,分析影响规范化抗凝治疗的因素,进一步提高规范化抗凝治疗的治疗率。方法选取2013-01~2015-12收治的510例非瓣膜性房颤患者的临床资料,采用CHADS2评分法筛选出符合要求使用华法林治疗的患者291例进行回顾性分析,评价其规范化抗凝治疗情况。结果 CHADS2评分≥2分符合要求使用华法林的291例患者中,规范化抗凝治疗只有61例(20.9%)。结论应加强对华法林抗凝治疗效果的认识,提高房颤患者规范化抗凝治疗的控制率和治疗率。     

华法林预防心房颤动患者发生脑梗塞的临床意义

目的:通过比较华法林与拜阿司匹林对非瓣膜性心房颤动(NVAF)的疗效及安全性,以明确NVAF患者抗栓治疗的最佳选择。方法:根据国际指南中关于NVAF血栓栓塞危险因素的建议,入选120例NVAF患者,随机均分为华法林组(目标INR 2～3)与阿司匹林(100mg/d)组,比较两组脑梗塞和出血事件的发生率。结果:华法林组脑梗塞发生率明显低于阿司匹林组(1.67%比8.33%,P<0.05)。华法林组7例(11.67%),阿司匹林组6例(10.00%)发生出血,华法林组出血发生率高于阿司匹林组,但差异无显著性(P>0.05),两组均无严重岀血情况。结论:华法林抗凝效果明显,可以安全、有效地减少和防止脑梗塞发生。     

华法林对高危持续性心房颤动患者血栓前状态和心功能的影响

目的探讨调整剂量华法林[国际标准化比值（INR）23]对高危持续性心房颤动（AF）患者血栓前状态和心功能的影响。方法99例高危持续性AF患者随机给予阿司匹林（100mg/d,阿司匹林组）或调整剂量华法林（华法林组）治疗1年。于治疗前、治疗后6个月和12个月分别检测血栓前状态（PTS）各分子标志物,采用免疫比浊法测定D-二聚体水平,采用ELISA双抗体夹心法测定血小板α-颗粒膜蛋白（GMP）-140、血浆血栓调节蛋白（TM）和血浆凝血酶-抗凝血酶Ⅲ复合物（TAT）水平;超声测定心排出量（CO）和左室射血分数（LVEF）,进行前后比较分析。随访中观察有无血栓栓塞和出血并发症发生。结果①与阿司匹林组比较,华法林组治疗6个月、12个月后D-二聚体、GMP-140、TAT、TM水平均显著降低,CO、LVEF均显著增加（P<0.05）;②随访期间两组均无血栓栓塞事件发生,华法林组有1例出现上消化道大出血,经治疗痊愈。结论调整剂量华法林能不同程度地改善高危AF患者的血栓前状态和心功能,疗效优于阿司匹林,治疗是安全的。     

Effect of non-vitamin K antagonist oral anticoagulants versus warfarin in heart failure patients with atrial fibrillation

Heart Failure Reviews - Several studies have investigated the efficacy and safety outcomes of non-vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in patients with atrial...     

A warfarin induction regimen for out-patient anticoagulation in patients with atrial fibrillation

Currently available protocols for induction of warfarin anticoagulation employ initial doses of 10 mg and are best suited to in-patient use. However, with the increasing number of elderly patients with atrial fibrillation requiring anticoagulation, there is a need for a less intense regimen which could be used for out-patients. We have established such a regimen and report on its prospective evaluation in 37 patients referred for out-patient initiation of warfarin, and a non-randomized comparison with 37 in-patients, with similar diagnoses, commenced on a traditional warfarin protocol. After exclusion of five patients on amiodarone, all of whom experienced supratherapeutic International Normalized Ratio (INR) results, the new out-patient regimen, employing an initial 5 mg dose, resulted in a lower maximum INR during the first 21 d therapy (median 2.9 v 4.0; P  = 0.0001) and fewer INRs > 4.5 (2/36 v 9/33) compared to the traditional 10 mg regimen. Time to reach stable anticoagulation was similar with each regimen; however, the 5 mg regimen gave a more accurate prediction of maintenance dose (correlation coefficient for predicted versus actual maintenance dose, r  = 0.985). In comparison to a traditional 10 mg protocol, the proposed 5 mg warfarin induction regimen proved both safer and more reliable for initiation of prophylactic anticoagulation in patients with atrial fibrillation.