华法林低强度抗凝对高龄老年非瓣膜病性心房颤动抗栓治疗的安全性

目的研究低抗凝强度的华法林治疗高龄老年非瓣膜病性永久性心房颤动(NVAF)患者血栓形成的安全性。方法入选NVAF患者按年龄分为两组:高龄老年组40例,年龄≥80岁,平均84.50±4.05岁,老年组40例,年龄60～79岁,平均74.50±4.00岁。两组采用华法林低强度抗凝,目标范围为国际标准化比值(INR)1.6～2.5。随访1年,观察两组患者用药的不良反应和华法林的安全用量范围。结果 INR在1.6～2.5时高龄老年组和老年组华法林维持剂量分别为1.25～3.75mg/d,平均2.86±0.62mg/d和1.88～3.75mg/d,平均2.66±0.12mg/d。INR在安全范围内华法林的用量两组比较无统计学差异。两组患者均未发现严重出血,高龄老年组与老年组分别发生轻度牙龈出血6例和7例、皮下淤血各3例、尿常规检查有红细胞2例和1例,粪便潜血弱阳性3例和2例;两组出血发生率差异无统计学意义(P0.05)。两组患者均无新的血栓栓塞事件发生。结论严密监测INR下调整华法林剂量对高龄老年NVAF患者治疗的安全性好。     

华法林剂量与国际标准化比率监测

目的 探讨影响华法林抗凝治疗剂量的可能因素,以便更正确地使用华法林.方法 服用华法林的患者196例,观察华法林治疗起始剂量、维持剂量、国际标准化比率(INR)监测及出血等不良反应.结果 多元线性回归分析提示年龄和体重与华法林维持剂量存在相关性(分别为r=0.307,P＜0.01和r=0.276,P＜0.01;两者一起r=0.390,P＜0.01).而体表面积和身高与华法林维持剂量无相关性,回归模型解释了约15%的剂量差异.目标INR在1.5～3.0时,华法林维持剂量为0.62～6.25 mg/d,平均为(2.03±0.90)mg/d.其中维持剂量≤2.0 mg/d的患者占63.3%,维持剂量在2.1～2.5 mg/d的患者占17.3%,维持剂量在2.6～3.5 mg/d的患者占10.2%,维持剂量＞3.5 mg/d的患者占9.2%.INR达到1.5需3～12 d,稳定于1.5～3.0需要8～40 d,中位时间为21 d.结论 华法林临床剂量使用个体差异大,与年龄、体重相关性较强,尚有85%的剂量差异在回归模型中无法解释,这可能与饮食、合并用药以及遗传等因素有关.     

双重抗血小板与华法林预防高危非瓣膜性心房颤动患者血栓栓塞的对照研究

目的 比较阿司匹林联合双嘧达莫与华法林预防高危非瓣膜性心房颤动(NVAF)患者血栓栓塞的有效性和安全性.方法 将确诊的140例高危NVAF患者,采用机械抽样法随机分为两组,分别给予调整剂量华法林抗凝治疗[华法林组78例,目标国际标准化比值(INR)为2.0～3.0,年龄>75岁者INR为1.6～2.5]和阿司匹林联合双嘧达莫治疗(联合治疗组62例,阿司匹林100mg1次/d+双嘧达莫100 mg 3次/d).观察两组患者死亡、血栓栓塞事件(缺血性脑卒中和周围动脉栓塞)及各种出血的发生率.结果 随访12～28个月.华法林组失访3例,发生缺血性脑卒中2例,严重出血2例,轻微出血6例;联合治疗组失访2例,发生缺血性脑卒中6例,周围动脉栓塞2例,轻微出血3例,无严重出血病例.华法林组血栓栓塞事件的发生率明显低于联合治疗组[2.7%(2/75)比13.3%(8/60),P<0.05];出血发生率高于联合治疗组,但差异无统计学意义[10.7%(8/75)比5.0%(3/60),P>0.05].结论 华法林抗凝治疗预防高危NVAF患者血栓栓塞事件的疗效优于阿司匹林联合双嘧达莫抗血小板治疗,当INR>3.0时出血发生率明显增加,严密监测下(INR 2.0～3.0)调整剂量华法林抗凝治疗安全有效.     

华法林抗凝治疗维持剂量与CYP2C9基因突变的关系

目的 探讨心脏瓣膜置换术后需长期口服华法林抗凝治疗的患者华法林维持剂量与细胞色素P4502C9(CYP2C9)基因CYP2C9*3(Ile359Leu)突变的关系.方法 93例心脏瓣膜置换术后需长期口服华法林抗凝治疗患者根据国际标准化比值(INR)1.5～2.0调整华法林的用量,应用聚合酶链反应-限制性片段长度多态性分析方法(PCR-RFLP)检测CYP2C9*3的突变情况,根据有无突变进行分组,比较有突变组和无突变组患者每周华法林的维持剂量.结果 93例口服华法林抗凝治疗患者中检测出CYP2C9*3突变的有14例,无突变的79例,突变组每周华法林维持剂量为(15.22±5.49)mg,无突变组每周华法林维持剂量为(19.83±5.99)mg,突变组华法林的维持剂量明显低于无突变组,两组间差别有统计学意义(t＝2.686,P＜0.05).结论 CYP2C9*3突变是不同个体间华法林维持剂量出现差异的主要原因之一,为了降低使用华法林时发生不良反应的风险,在口服华法林抗凝治疗时应检测CYP2C9*3的突变情况.     

华法林抗凝治疗非瓣膜病房颤的研究

目的华法林抗凝治疗非瓣膜病性心房颤动（AF）患者的抗栓疗效和出血危险性。方法140例非瓣膜病性AF患者分为两组：治疗组74例,服用华法林服用从1．5mg开始,1次／d,根据血浆凝血酶原时间国际标准化比率（INR）调整华法林剂量,INK达标为2．0—3．0,持续服药,并随访1年;对照组66例,持续服安慰剂,并随访1年。观察两组栓塞事件及出血发生率。结果治疗组栓塞事件及出血发生率分剐为o％和2．7％,对照组栓塞事件及出血发生率分别为4．5％和0％。两组比较差畀均有统计学意义（P〈0．01）。结论华法林抗凝治疗非瓣膜病性AF患者,华法林抗凝目标INK值在2。0—3．0是安全有效。     

华法林对围产期心肌病抗凝治疗的临床观察

目的通过对比接受华法林治疗3个月与6个月时的临床效果,以探讨华法林对围产期心肌病患者的影响。方法选择2010年12月-2012年12月住院的42例围产期心肌病患者作为研究对象．按照入院顺序将上述患者随机分为两组．两组患者均予以抗心力衰竭治疗,20例（A组）使用华法林治疗3个月,22例（B组）使用华法林治疗6个月,调整华法林剂量将国际标准化比值维持在2．0～3．0,观察比较两组血浆D-二聚体、深静脉血栓和出血率。结果两组治疗后D-二聚体水平显著下降,B组的下降效果明显好于A组,随访发现B组的深静脉血栓形成率明显低于A组,两组出血率比较不存在显著性差异。结论华法林对围产期心肌病抗凝效果明显。持续治疗时间可能是影响抗凝效果的重要因素。     

心脏瓣膜置换术后华法林疗效与维生素K环氧化物还原酶复合体亚单位1基因多态性的相关性研究

目的 探讨心脏瓣膜置换术后口服华法林的临床疗效及维生素K环氧化物还原酶复合体亚单位1(VKORC1)基因多态性对心脏瓣膜置换术后患者华法林维持剂量的影响.方法 选择行心脏瓣膜置换术的患者159例,术后口服华法林进行抗凝治疗,记录患者的凝血酶原时间(PT)、国际标准化比值(INR),统计安全的PT和INR范围;调整华法林维持剂量,采用PCR-PFLP技术对心脏瓣膜置换术患者进行VKORCI基因多态性检测,并进行比较.结果 心脏瓣膜置换术后口服华法林的PT安全监测范围为15.36～24.82 s,INR安全监测范围为1.33～2.62.抗凝过程中出血并发症的发生率为13.21％(21/159),VKORC1基因AA型华法林周剂量[(24.28±10.79) mg]显著高于GA型[(16.64±7.43) mg]和GG型[(12.12±7.17) mg],差异有统计学意义(P＜0.05或＜0.01).结论 VKORC1基因多态性是个体之间华法林维持剂量出现差异的主要因素,不同基因型患者间华法林用量存在一定的差异.心脏瓣膜置换术后口服华法林的临床PT及INR安全监测范围低于欧美国家的推荐范围,因此术后患者应定期进行指标的监测.     

华法林预防非瓣膜性心房颤动患者脑梗死的临床研究

目的 探讨华法林预防非瓣膜性心房颤动(NVAF)患者并发脑梗死的疗效和安全性.方法 选择NVAF患者136例,按随机数字表法分为华法林组[口服华法林钠片,初始剂量为2.0mg/d,目标国际标准化比值(INR)为2.0～3.0]、阿司匹林组(口服阿司匹林100 mg/d)和对照组(未用抗栓药物).常规门诊随访,调整华法林剂量并记录三组患者的终点事件和不良反应发生情况,随访时间18个月.结果 136例患者失访4例,进入研究的132例患者中,男77例,占58.3%.华法林组口服华法林钠片的剂量为(2.5±1.0)mg.随访期间共发生主要终点事件12例,其中华法林组1例(2.50%,1/40)、阿司匹林组4例(9.52%,4/42)、对照组7例(14.00%,7/50),三组主要终点事件发生率比较差异无统计学意义(x2=2.084,P=0.353).伴随≥3种危险因素的三组之间生存曲线比较差异有统计学意义(x2=6.404,P=0.041).华法林组出血并发症发生率高于阿司匹林组[5.00%(2/40)比2.38%(1/42)],但差异无统计学意义(P＞0.05).结论 伴随≥3种危险因素的NVAF患者,华法林可改善患者的生存率,华法林导致出血并发症多数发生在INR＞3.0.严密监测下(INR 2.0～3.0)的调整剂量华法林安全有效.     

利伐沙班与华法林治疗静脉血栓性疾病的比较研究

[目的]比较观察利伐沙班与华法林治疗静脉血栓性疾病的疗效及安全性.[方法]其中口服华法林组15例,初始治疗与低分子肝素联合应用,起始剂量为2.5～3.0mg/每日监测INR值,INR值稳定在2.0～3.0时停用低分子肝素,继续予以华法林口服,每3日监测INR值并调整剂量,维持INR值2.0～3.0之间.后每2周监测INR值.利伐沙班组14例,口服利伐沙班片剂10 mg,Bid.观察3个月.观察患者的血栓栓塞症状的缓解时间、新发生的肺血栓拴塞症、治疗期间的出血事件,抗凝治疗期间任何原因导致的药物剂量的调整及停药事件.[结果]两组间静脉血栓栓塞的缓解时间、新的DVT的出现及新发的肺静脉血栓栓塞症无明显差异,华法林组出血事件较之利伐沙班组多.华法林与利伐沙班口服治疗静脉血栓栓塞症两者之间疗效无明显差异,但华法林组出血事件较之利伐沙班组增加,华法林组药物调整的频率明显增加.[结论]利伐沙班与华法林静脉血栓栓塞症的疗效相当,但利伐沙班较之华法林的出血事件较少,不需频繁调整药物剂量,更为安全,方便.     

心理护理干预对老年房颤患者抗凝治疗依从性的影响

目的：了解心理护理干预对老年房颤患者抗凝治疗依从性的影响。方法对37例老年房颤行抗凝治疗的患者实施心理护理干预的临床资料展开回顾性分析。结果37例老年房颤患者华法林抗凝治疗的平均剂量为（2.28±0.41）mg/d,平均INR值为（2.13±0.45）,基本满足国内外治疗指南要求2.0-3.0目标范围,无一例发生出血并发症,所有病患均按要求随诊并服药,护理满意度100%。结论：心理护理干预可提高老年房颤患者抗凝治疗依从性,缓解病患焦虑、抑郁情绪,改善患者生活质量。     

Heparin and warfarin: use of anticoagulants in the prevention and treatment of venous thrombosis and pulmonary embolism.

The physician frequently encounters the problems of deep vein thrombosis and pulmonary embolism. Recently, a number of studies have been published which are of considerable help in the management of these disorders. It has been shown that in many cases, low-dose heparin is effective in the prevention of both venous thrombosis and pulmonary embolism. However, once venous thrombosis has already occurred, it is necessary to use full-dose heparin, preferably by the continuous intravenous route, with maintenance of the partial thromboplastin time (PTT) at 1 1/2 times the control at all times. Although monitoring the PTT may not prevent hemorrhage, it will help prevent further thrombosis. Heparin is generally continued for seven to ten days. During this time warfarin is generally begun, and it is important to continue the patient on warfarin for five to seven days while the patient is receiving intravenous heparin therapy. After stopping heparin, oral anticoagulation with warfarin should be continued for six weeks. Then, in the absence of a previous history of venous thromboembolism or a known predisposing condition, it is safe to abruptly discontinue anticoagulation in most patients.     

低分子量肝素联合华法林治疗晚期肺癌合并急性肺栓塞临床研究

目的 观察低分子量肝素联合华法林治疗晚期肺癌合并急性非大面积肺栓塞的疗效及对呼吸困难症状的影响.方法 2008年7月至2010年6月收治ⅢB～Ⅳ期肺癌合并肺栓塞患者15例,所有患者均经螺旋CT动脉造影(SCTPA)确诊为急性非大面积肺栓塞.给予依诺肝素(1mg/kg体重)每12 h皮下注射1次(7～14 d),并在应用依诺肝素48 h后加用华法林,调整华法林剂量使国际标准化比值(INR)维持在2.0～3.0.监测患者治疗前和治疗后4、7、14d的呼吸困难分级(MRC分级)、动脉血气分析等指标的变化,观察疗效.结果 2例合并下肢深静脉血栓形成(DVT)患者因并发多器官功能衰竭分别于治疗第6天和第11天死亡,其余13例患者治愈6例,显效5例,好转2例,中位生存期9.2个月.治疗后4、7、14d患者的MRC分级由(3.1±0.5)级降低至(1.9±0.8)、(1.5±0.5)、(0.6±0.6)级,动脉血氧分压(PaO2)由(60.5±7.2) mm Hg(1 mm Hg=0.133 kPa)升高至(76.1±9.7)、(81.6±9.2)、(86.2±7.5) nn Hg,血浆D-二聚体由(9.44±5.29) mg/L降低至(4.33±3.34)、(0.88±0.32)、(0.41±0.17) mg/L,肺泡-动脉血氧分压差[(P(A-aO2)由(38.5±6.7)mm Hg降低至(35.5±5.1)、(29.3±3.2)、(24.1±4.1) mm Hg,其中PaO2、MRC分级、血浆D-二聚体治疗后4、7、14d与治疗前比较差异均有统计学意义(P＜0.05),而P(A-a)O2治疗后7、14d与治疗前比较差异有统计学意义(P＜0.05).在抗凝治疗期间无一例患者出现危及生命的大出血及血栓栓塞.结论 低分子量肝素联合华法林治疗晚期肺癌合并急性非大面积肺栓塞可显著改善患者的呼吸困难症状,不良反应少,安全性较高.     

Utilization of Parenteral Anticoagulants and Warfarin: Impact on the Risk of Venous Thromboembolism Recurrence in the Outpatient Setting

Background

Clinical guidelines recommend parenteral anticoagulation therapy with an early initiation of warfarin therapy for the treatment of patients with acute venous thromboembolism (VTE) and the prevention of recurrence.

Objectives

To evaluate the outpatient utilization of parenteral anticoagulant therapy and warfarin among patients with VTE, and to examine the effects of parenteral anticoagulant use and the time to warfarin initiation from VTE diagnosis on the risk for VTE recurrence.

Methods

The Truven Health MarketScan Commercial Claims Database was used to identify patients aged 18 to 64 years who had an outpatient claim for deep-vein thrombosis or pulmonary embolism between January 2010 and December 2011 (ie, index date) and had no VTE diagnosis or treatment during the 12 months before the index date, had no hospital or emergency department VTE claim within 7 days after the index outpatient VTE claim, and had received warfarin <30 days after the index date. A recurrent VTE event was defined as a VTE-related emergency department visit or hospitalization within 8 to 365 days after the index date. A Cox proportional hazards model was used to estimate the adjusted hazard ratio (HR) associated with VTE recurrence risk related to parenteral anticoagulant use and warfarin initiation timing.

Results

A total of 5820 patients were included in the study (mean age, 50.5 years); of these, 45% were female. A total of 75.7% (4403) of the patients receiving warfarin also received a parenteral anticoagulant, and the median time from VTE diagnosis to warfarin initiation was 5 days for parenteral anticoagulant users compared with 11 days for nonusers. Parenteral anticoagulant use was associated with a 49% recurrent VTE risk reduction (HR, 0.51; 95% confidence interval [CI], 0.43–0.60; P <.001). Each day of delayed warfarin initiation from the diagnosis of acute VTE was associated with a 1% increase in the risk for VTE recurrence (HR, 1.01; 95% CI, 1.01–1.02; P = .003).

Conclusions

Overall, 1 in 4 patients with VTE who had received warfarin in the outpatient setting did not receive parenteral anticoagulation therapy. Among those who received warfarin, its initiation was not always timely, despite its positive effects on reducing VTE recurrence. These findings highlight the potential quality-of-care concerns associated with the failure to use or the delayed implementation of guideline-recommended VTE treatment, and the need to improve compliance with clinical guidelines in the treatment of patients with VTE.Venous thromboembolism (VTE) encompasses deep-vein thrombosis (DVT) and pulmonary embolism (PE). VTE is a chronic disease that is associated with a high risk for recurrence, especially during the initial months of therapy.1–7 The risk for VTE recurrence is higher for patients with “unprovoked” VTE (ie, VTE occurring in the absence of malignancy or any of the factors of “provoked” VTE) than for patients with provoked VTE (ie, VTE occurring within 3 months of hospitalization, major surgery, pregnancy, trauma, or fracture).8 The rates of VTE recurrence in patients with unprovoked VTE have been estimated at 10% after 1 year and 30% after 5 years of the first VTE event compared with patients with VTE provoked by surgery, in whom the recurrence rates are estimated to be 1% after 1 year and 3% after 5 years.8VTE recurrence is recognized as an important risk factor for mortality and long-term complications, such as postthrombotic syndrome after DVT and pulmonary hypertension after PE. Recurrent VTE events also pose a significant economic burden to the healthcare system. In a recent retrospective analysis of claims data, patients with VTE recurrence were found to have 2.2-fold to 3-fold higher healthcare costs in the 1 year after their first VTE event, which was primarily driven by an increase in inpatient services utilization.7The American College of Chest Physicians (ACCP) recommends initial parenteral anticoagulant therapy as an option for the initial treatment of acute DVT or PE.8 The ACCP guidelines recommend the early initiation of warfarin therapy rather than delayed initiation (eg, on the same day as parenteral therapy is started), and the continuation of parenteral anticoagulation therapy for a minimum of 5 days until the international normalized ratio (INR) is ≥2.0 for at least 24 hours. The ACCP also recommends continuation of anticoagulation therapy for 3 months in patients with acute DVT and PE to allow for the complete treatment of the acute episode of VTE and to prevent recurrent episodes of VTE.8The outpatient treatment of uncomplicated VTE has become more common since the availability of subcutaneous low-molecular-weight heparin (LMWH) therapy as an alternative to intravenous unfractionated heparin for the treatment of VTE.8–10 Although the administration of heparin therapy and INR monitoring are much easier in the inpatient setting, there are challenges associated with the outpatient treatment of VTE. The outpatient use of LMWH requires the coordination of care, laboratory monitoring, and patient education and participation in treatment.11It remains unclear how well parenteral anticoagulation therapy utilization in the outpatient clinical practice is consistent with the treatment guidelines for VTE. In addition, although previous randomized clinical trials suggest that the early initiation of warfarin therapy with a shorter course of heparin therapy for approximately 5 days is as effective as the delayed initiation of warfarin with a 10-day course of heparin, and that this approach has the benefit of reducing the risk for heparin-induced thrombocytopenia,8 it remains unclear how well this recommendation has been adopted in real-world clinical settings.The objectives of this study were to assess the utilization of parenteral anticoagulation therapy and the timing of the initiation of warfarin for the treatment of VTE in the outpatient setting, and to examine the effects of parenteral anticoagulation therapy and the timing of warfarin initiation relative to a diagnosis of VTE on the risk of VTE recurrence.

KEY POINTS

• ▸ Recurrent venous thromboembolism (VTE) is a risk factor for mortality and long-term, serious complications; the risk for recurrence is especially high in the early months of an acute VTE event.
• ▸ Recurrent VTE poses a significant economic burden to the healthcare system.
• ▸ Current clinical guidelines recommend the early addition of warfarin to parenteral anticoagulation to reduce the risk for VTE recurrence.
• ▸ In this study of 4403 patients with acute VTE who received parenteral anticoagulants in the outpatient setting, only 25% of patients received warfarin on the same day of initiating parenteral anticoagulant therapy; 52% received warfarin 3 days after initiating parenteral anticoagulant therapy.
• ▸ Overall, parenteral anticoagulation plus warfarin reduced the risk for recurrent VTE by 49% over 1 year.
• ▸ In this study, each day that the initiation of warfarin was delayed from the VTE diagnosis translated to a 1% increase in VTE recurrence risk.

     

老年心房纤颤患者不同抗栓治疗方案的临床观察

目的观察老年心房纤颤(房颤)患者使用口服抗凝药进行抗栓治疗的临床效果。方法选择2010—2011年年龄大于75岁持续性房颤患者232例。依据CHA2DS2系统评分大于2分栓塞风险较高,建议口服抗凝药抗栓治疗,HAS-BLED评分系统大于3分相对出血风险较高,需综合评估风险与收益选择治疗方案。根据不同的抗栓治疗方案将所有病例(232例)随机分为华法林组(95例)、阿司匹林组(103例)与氯吡格雷组(39例)。记录所有患者基本临床资料(性别、年龄、高血压病史、糖尿病史、卒中史、冠心病史等),观察各组间基本资料分布情况和口服药物6个月内定期随访患者不良事件的发生情况。结果在华法林组有高血压59例(62.1%),阿司匹林组75例(72.8%),高于氯吡格雷组7例(20.6%),经比较,差异有统计学意义(P0.01);其他基本临床资料3组间差异无统计学意义。华法林组CHAD2S2-VASc评分明显高于阿司匹林组和氯吡格雷组,差异有统计学意义(4.2±1.1 vs 3.9±0.9,3.6±0.7,P0.05);栓塞发生率氯吡格雷组4例(11.8)、阿司匹林组9例(8.7),与华法林组1例(1.1%)比较,差异有统计学意义(P0.05)。3组间HAS-BLE评分、轻微出血、大出血比较,差异无统计学意义。3组均无死亡病例。结论对于栓塞及出血风险均相对较高的老年房颤患者,使用口服抗凝药将国际标准化比值(INR)控制在2.0～3.0之间可明显降低栓塞发生率,并未明显增加出血风险。     

58例老年人肺血栓栓塞的临床分析

目的 探讨老年人（〉70岁）肺血栓栓塞（PTE）的临床特点及溶栓、抗凝治疗的疗效。方法 回顾性分析58例70岁以上老年PTE患者的临床表现、诊断方法及溶栓、抗凝治疗的疗效。结果 螺旋CT和放射性核素肺通气／灌注（V／Q）扫描检出阳性率分别为95．7％和62．5％；临床误诊率为46．5％；溶栓＋抗凝、抗凝、抗血小板聚集治疗有效率分别为91．3％、75．8％和0％；治愈率分别为47．8％、17．2％和0％。结论 老年人（〉70岁）PTE最常见危险因素为下肢深静脉血栓（DVT）形成；临床表现复杂多样；螺旋CT对老年人PTE诊断更具有可靠性和准确性。溶栓和抗凝治疗安全、有效。     

老年慢性房颤患者抗栓治疗调查研究

目的探讨老年慢性房颤患者脑卒中预防。方法对我院就诊的老年慢性房颤患者资料进行随访调查,对比服用华法林和阿斯匹林药物后,患者缺血性脑卒中及脑出血并发症的发生率。结果华法林组缺血性脑卒中发病率同阿司匹林组比较显著下降;华法林组与阿司匹林组并发非致死性出血机率无统计学差异。结论对于老年慢性房颤患者缺血性脑卒中的预防,华法林比阿司匹林效果明显。     

心房颤动住院患者抗凝治疗的回顾分析研究

目的通过对280例房颤住院患者的病历资料进行回顾性分析,旨在评价房颤患者的抗凝治疗情况。方法对我院2000年4月-2007年2月出院诊断为持续性房颤的280例患者的住院资料进行详细登记及回顾性总结,建立患者的数据库,利用SPSS软件进行分析。结果应用阿司匹林抗血小板治疗83例,发生脑栓塞14例(16.86%)。用华法林抗凝治疗的患者197例,发生脑栓塞8例(4.06%)(P<0.05),提示华发林抗凝治疗的脑卒中患者患病率低于应用阿司匹林的抗血小板治疗的患者。口服华发林过程中出现出血事件为21例,进行Logistic回归分析,结果提示与口服华发林相关的出血高危因素为慢性肝病,收缩压>160mmHg,年龄>70岁。结论华法林抗凝治疗优于阿司匹林的抗血小板治疗。口服华发林危险因素为慢性肝病,收缩压>160mmHg,年龄>70岁,单纯监测INR是不够的。     

社区老年房颤患者抗凝治疗现状单中心横断面调查分析

目的:了解社区65岁及以上老年房颤患者抗凝治疗和社区随访情况,为进一步规范抗凝治疗提供理论基础和建议.方法:采用回顾性分析方法,入选2017-2018年本社区65岁及以上老年人心电图或动态心电图诊断房颤的166例患者,通过查阅居民电子健康档案、门诊随访和电话随访方式,记录性别、年龄、主要疾病诊断、CHA2DS2-VAS...     

273例高龄离退休老干部心房纤颤抗栓治疗分析

目的分析近5年离退休老干部发生心房纤颤(Af)及抗栓治疗后血管事件发生情况。方法回顾性分析2009年1月~2014年1月在我科住院及门诊患有Af的离退休老干部患者273例,记录其主要合并疾病、抗栓治疗选择及5年内血栓栓塞、严重出血及死亡事件发生情况。结果 273例患者中共发生血栓栓塞事件60例,严重出血事件6例,其中华法林抗凝治疗32例,随访期间停用华法林5例,阿司匹林治疗107例,氯吡格雷治疗95例,阿司匹林联合氯吡格雷治疗35例,抗栓时间平均在3个月至3年;华法林与单用阿司匹林或氯吡格雷相比抗栓效果显著(P0.01),与阿司匹林联用氯吡格雷组相比差异无统计学意义(P0.05);华法林组出血事件明显低于单用阿司匹林组或联用氯吡格雷组(P0.05),与单用氯吡格雷组差异无统计学意义(P0.05)。结论针对高龄心房纤颤患者,在严密监测国际标准化比值(INR)情况下,华法林抗凝治疗安全有效,患者获益更大。     

Quality assessment of oral anticoagulant treatment in the Beer-Sheba district.

OBJECTIVE: To evaluate the adequacy of oral anticoagulation therapy in patients with either prosthetic heart valves or atrial fibrillation. DESIGN: Adequacy of anticoagulation therapy of patients treated with warfarin was determined before and after implementation of an improvement programme. SETTING: The central haematology laboratory of the Soroka Medical Center, Beer-Sheba Israel. STUDY PARTICIPANTS: One hundred and ten patients treated with chronic anticoagulation therapy were evaluated by measuring the international normalized ratio of the prothrombin time before and after implementation of an improvement plan aimed at improving anticoagulation control. INTERVENTION: A programme that included physician and patient education and procedural changes covering all aspects of anticoagulation therapy was implemented. MAIN OUTCOME MEASURE: The percent of international normalized ratio tests below, within and above the therapeutic range was determined. RESULTS: Prior to implementation of an improvement plan, only 32% of the measured international normalized ratio values were within the therapeutic range. 16% were above and 52% were below therapeutic range. Improvement intervention led to an increase in the proportion of international normalized ratio tests that fell within the therapeutic range from 32% to 43.2%. CONCLUSIONS: Improvement in the control of anticoagulation therapy of patients receiving long-term warfarin treatment is possible. A combined effort involving the community, physician and patient is required.