老年心房颤动的华法林抗凝治疗

目的：了解临床实践中心房颤动（房颤）患者接受抗凝治疗的具体情况。方法：每日晚饭后服华法林,起始剂量3．0mg／d,每5～7天测量1次INP,使INR在2．0～2．5。INP〈2．0时,华法林剂量每3-5天增加0．5mg,直至达标,当INP〉2．5时,当日起药物剂量减0．5mg,直至达标。结果：维持剂量为（2．35±0．44）mg,最高3．5mg,最低1．5mg,其中87．5％患者维持用量为2．0～3．0mg。达标时间为（10．5±3．4）d,最高21d,最低5d,其中74．5％在14d内达标。结论：当前基层医院房颤抗凝治疗率极低,应提高广大医务人员与患者对房颤并发栓塞的危险性的认识,减少房颤患者栓塞事件的发生。     

华法林在房颤抗凝治疗中的应用

房颤的抗凝治疗历来是一个值得关注的问题,房颤患者经过抗凝治疗后可以明显降低血栓和脑卒中的发病率。本文根据近年研究,对房颤华法林抗凝治疗的适应证与注意事项、如何监测及调整剂量、抗凝过度的处理等问题做一概述。     

华法林在心房颤动长期抗凝治疗中的合理应用

心房颤动(房颤)主要危害之一是血栓栓塞,脑栓塞是房颤引起的最主要的栓塞事件,也是房颤患者致残率和病死率最高的并发症。我国部分地区房颤住院病例回顾性调查资料中,房颤患者脑卒中的患病率为17.5%[1]。北京协和医院单中心研究发现,未抗凝治疗的房颤患者缺血性卒中的年发生率为4.1%,且半数患者遗留不同程度的肢体障碍[2]。因此,国内外     

华法林在心房颤动长期抗凝治疗中的合理应用

心房颤动(房颤)主要危害之一是血栓栓塞,脑栓塞是房颤引起的最主要的栓塞事件,也是房颤患者致残率和病死率最高的并发症.我国部分地区房颤住院病例回顾性调查资料中,房颤患者脑卒中的患病率为17.5%[1].北京协和医院单中心研究发现,未抗凝治疗的房颤患者缺血性卒中的年发生率为4.1%,且半数患者遗留不同程度的肢体障碍[2].因此,国内外建议与共识[3,4]均高度强调了房颤防栓的重要性,建议除孤立性房颤和有禁忌证外,所有房颤患者应当抗栓治疗.房颤血栓栓塞预防试验的荟萃分析提示,华法林使脑卒中的相对危险降低68%[5].目前临床上公认的首选抗栓药物仍是华法林.     

房颤患者服用华法林的健康教育体会

目的：使房颤患者及家属了解和掌握华法林抗凝治疗的重要性、注意事项及不良反应等。方法：通过对房颤患者及家属在应用华法林抗凝治疗前,强化健康教育。结果：病人及家属对华法林的抗凝治疗有了正确的认识和一定程度的掌握,提高了患者的用药依从性,实施健康教育的患者能够按时随访凝血酶原时间（PT）及国际标准化比值（INR）。有效减少了抗凝治疗的并发症,未出现血栓栓塞事件,无严重出血发生。     

华法林用于心房颤动的抗凝效果观察

目的:观察华法林用于预防心房颤动患者血栓栓塞的效果.方法:将心房颤动患者248例随机分为华法林组128例和阿司匹林组120例,比较2组患者血栓栓塞的发生情况.结果:华法林组血栓栓塞发生率为3.91%低于阿司匹林组的15.00%,差异有统计学意义(P<0.05).结论:应用华法林进行抗凝治疗安全可靠,注意国际标准化比值(INR)检测,随时调整药物的剂量可有效避免血栓栓塞发生、防止出血不良反应的出现.     

华法林用于心房颤动的抗凝效果观察

目的观察华法林用于预防心房颤动患者血栓栓塞的效果。方法将心房颤动患者248例随机分为华法林组128例和阿司匹林组120例,比较2组患者血栓栓塞的发生情况。结果华法林组血栓栓塞发生率为3.91%低于阿司匹林组的15.00%,差异有统计学意义(P<0.05)。结论应用华法林进行抗凝治疗安全可靠,注意国际标准化比值(INR)检测,随时调整药物的剂量可有效避免血栓栓塞发生、防止出血不良反应的出现。     

华法林与阿司匹林对心房颤动患者抗凝的效果比较

心房颤动(房颤)是临床上最常见的心律失常之一,可致心悸、胸闷、头昏等症,还易引起房内血栓形成,部分血栓脱落可致体循环动脉栓塞,临床以脑栓塞最常见,常导致死亡或病残。本文通过对使用华法林和阿司匹林的房颤患者对     

我院心内科房颤患者华法林治疗的健康宣教

目的探讨华法林治疗的健康宣教对心房颤动（房颤）患者预后的重要性,指导患者达到安全有效的抗凝状态。方法对30例患者进行抗凝治疗宣教,饮食及用药指导,明确监测凝血功能的重要性和必要性。结果30例患者均使用华法林终身抗凝治疗,住院前均掌握华法林的作用及不良反应,出院后无1例因随意停药而致血栓形成。其中有3例患者发生出血并发症,因出血灶不大,分别经过对症处理后,症状消失。结论应加强对房颤患者的抗凝健康宣教,提高患者的认识,学会自我保健。     

房颤患者应用华法林抗凝治疗的临床体会

目的探讨房颤患者应用华法林抗凝治疗的疗效。方法用药前测INR1次,每天服用1次华法林,初始剂量2．5—3．0mg／d,应用华法林3d后复查INR,以后每天监测,根据INR调整剂量,每次0．5mg为调整单位。若INR连续2d稳定在2．0～3．0之间,每周检测2～3次,以后每周检测1次,1个月后改为每月检测1次,6个月后改为每2个月检测1次。若有出血等不良反应和栓塞并发症发生时即查血浆凝血酶原时间（PT）、INR。结果52例患者均得到随访,随访时间6个月～4年,华法林维持量为（3．0±0．05）mg／d。随访期间血栓栓塞并发症及不良反应脑栓塞2例,其中1例为既往发生过脑卒中的高血压患者;1例为瓣膜病患者;脑出血2例,为人工瓣膜患者,因咳嗽、咯痰、发热,在院外静点头孢曲松钠3．0g（1次／d）,1周后复查INR为8．45;黑便1例、血尿1例、球结膜出血2例、皮下出血2例、牙龈出血2例,经调整华法林剂量及对症处理后出血症状消失。结论心房颤动一旦确诊,又无抗凝禁忌,应常规给予华法林抗凝治疗,以尽早达到治疗效果。     

住院心房颤动患者华法林的使用分析

目的分析比较瓣膜性心房颤动和非瓣膜性心房颤动住院患者华法林使用情况及国际标准化比值（INR）达标状况。方法收集969例住院心房颤动患者的病历资料进行回顾性分析。将患者分为瓣膜性心房颤动和非瓣膜性整体的心房颤动2组,分析2组华法林使用率和达标率的差异及应用华法林患者的INR达标水平。结果瓣膜性心房颤动患者161例中使用华法林者93例,占57.8%;非瓣膜性心房颤动患者808例中使用华法林者214例,占26.5%。93例使用华法林的瓣膜性心房颤动患者中,INR值在2.0～3.0者21例,占22.6%;214例使用华法林的非瓣膜性心房颤动患者中,INR值在2～3者38例,占17.8%。2组患者华法林的使用率比较差异有统计学意义（P＜0.05）,INR达标率比较差异无统计学意义（P＞0.05）。使用华法林的307例心房颤动患者的达标率INR在2.0～3.0者59例,占19.2%;INR＜2.0者230例,占74.9%;INR＞3.0者为18例,占5.9%。结论华法林在心房颤动患者中的使用率低且使用华法林后INR的达标率低。     

Direct costs of warfarin treatment among patients with atrial fibrillation in a Finnish health care setting

ABSTRACT

Objective: The main objective was to estimate the mean direct costs of warfarin treatment for atrial fibrillation (AF) patients. Secondly, the costs of initiating warfarin treatment during a 60-day period and the impact of International Normalized Ratio (INR) and co-morbidities on costs were estimated.

Design and data: The study was performed as a retrospective cohort study over a 12‐month period in a Finnish communal health care setting. All AF patients aged 65 years or older (n = 250) with warfarin treatment were identified from the database of the health service district of an urban area. Patient specific information related to co-morbidities, INR-control, complications and health care resource use were collected. Cost information was obtained from the Finnish national health care unit cost list.

Methods: The effect of treatment balance and other background variables on treatment costs were evaluated using ordinary least squares regression (OLS), log-transformed OLS and generalized linear model (GLM). The mean costs were calculated on the basis of the different models and bias corrected and accelerated (BCa) bootstrap confidence intervals (CIs) were calculated for the mean costs.

Results: The best fitting cost model was log-transformed OLS. The costs of warfarin treatment on the basis of the log-transformed model were 589.82 euros (BCa 95% CI: 586.68–591.99) per patient compared to 616.00 euros (BCa 95% CI: 579.98–652.96) obtained with the OLS-model. For the treatment initiation period, the mean costs were 263 euros (BCa 95% CI: 218.90–314.71). Depending on the way that INR-control was defined, the mean costs were 95.27 euros or 166.92 euros higher for patients who were not in the defined INR-balance.

Conclusions: The INR-control has a significant impact on the warfarin treatment costs. The choice of model influences the estimated mean costs. In addition, different models identify statistically significant effects between different background variables and costs.     

Cost effectiveness of rivaroxaban versus warfarin among nonvalvular atrial fibrillation patients in Saudi Arabia: A Single–Center retrospective cohort study

BackgroundRivaroxaban is a novel oral anticoagulant (NOAC) that is commonly used for stroke prevention among patients with atrial fibrillation (AF). However, its cost effectiveness in reducing the risk of hospitalization and mortality in comparison to warfarin among nonvalvular AF patients in Saudi Arabia is largely unknown.MethodsThis was a single-center retrospective chart review of adult patients (≥18 years) with nonvalvular AF who were treated with warfarin or rivaroxaban for at least 12 months. Patients with mitral valve stenosis were excluded from the study. Multiple logistic regression was conducted to examine the risk of hospitalization and mortality as a composite outcome, and all annual healthcare costs were captured. Inverse probability treatment weighting with bootstrapping was conducted to determine the mean costs and effectiveness rates.ResultsTwo-hundred and twenty-six patients (142 on rivaroxaban and 84 on warfarin) met the inclusion criteria and were included in the analysis. Most of the patients were females (65.91 %), had diabetes (50.57 %) and hypertension (73.76 %), and with a mean age of 68.95 ± 12.55 years. No significant difference in the odds of the composite outcome for rivaroxaban versus warfarin was found (OR = 0.785, 95 % CI = [0.427–1.446], p = 0.443). Rivaroxaban resulted in a mean annual cost saving of $13,260.79 with an 87.65 % confidence level that it would be more effective than warfarin with a mean difference in effectiveness rate of 0.168 % (95 % CI [-5.210–18.36]).ConclusionRivaroxaban was associated with lower direct medical costs and non-inferior effectiveness among nonvalvular AF patients in comparison to warfarin.     

Cost effectiveness of rivaroxaban versus warfarin among nonvalvular atrial fibrillation patients in Saudi Arabia: A Single–Center retrospective cohort study

BackgroundRivaroxaban is a novel oral anticoagulant (NOAC) that is commonly used for stroke prevention among patients with atrial fibrillation (AF). However, its cost effectiveness in reducing the risk of hospitalization and mortality in comparison to warfarin among nonvalvular AF patients in Saudi Arabia is largely unknown.MethodsThis was a single-center retrospective chart review of adult patients (≥18 years) with nonvalvular AF who were treated with warfarin or rivaroxaban for at least 12 months. Patients with mitral valve stenosis were excluded from the study. Multiple logistic regression was conducted to examine the risk of hospitalization and mortality as a composite outcome, and all annual healthcare costs were captured. Inverse probability treatment weighting with bootstrapping was conducted to determine the mean costs and effectiveness rates.ResultsTwo-hundred and twenty-six patients (142 on rivaroxaban and 84 on warfarin) met the inclusion criteria and were included in the analysis. Most of the patients were females (65.91 %), had diabetes (50.57 %) and hypertension (73.76 %), and with a mean age of 68.95 ± 12.55 years. No significant difference in the odds of the composite outcome for rivaroxaban versus warfarin was found (OR = 0.785, 95 % CI = [0.427–1.446], p = 0.443). Rivaroxaban resulted in a mean annual cost saving of $13,260.79 with an 87.65 % confidence level that it would be more effective than warfarin with a mean difference in effectiveness rate of 0.168 % (95 % CI [-5.210–18.36]).ConclusionRivaroxaban was associated with lower direct medical costs and non-inferior effectiveness among nonvalvular AF patients in comparison to warfarin.     

慢性房颤华法令抗凝治疗的理想INR值探讨

目的:探讨慢性房颤华法令抗凝治疗的理想国际标准化比值(INR)。方法:对115例有血栓栓塞高危因素的慢性房颤患者给予华法令抗凝治疗,定期随访INR,同时观察治疗中发生的血栓栓塞和出血事件。结果:115例患者中有8例共10次发生血栓栓塞事件,7例7次发生与抗凝有关的出血事件,10次血栓栓塞事件中9次发生在INR<1.7,而所有的出血事件都发生在INR>3.5,INR 1.7～3.5时栓塞或出血发生率均较低。结论:INR 1.7～3.5是慢性房颤华法令抗凝治疗较理想的抗凝强度。     

延伸护理对房颤患者服用华法林治疗依从性的影响

目的 探讨延伸护理对房颤患者服用华法林治疗依从性的影响.方法 选择2012年10月至2013年10月在我科住院房颤患者100例随机分为对照组（48例）和观察组（52例）,对照组给予常规护理,观察组在常规护理的基础上给予延伸护理,比较两组患者华法林治疗依从性.结果 观察组患者采用延伸护理后,其服用华法林治疗依从性明显提高,出血或栓塞等不良事件6例,占11.5％,与对照组比较,出血或栓塞等不良事件10例,占20.8％,P＜0.05,差异有统计学意义.结论 采用延伸护理能有效提高房颤患者服用华法林治疗的依从性,降低出血或栓塞等不良事件的发生率,提高生存质量.     

Factors associated with warfarin discontinuation,including bleeding patterns,in atrial fibrillation patients

Abstract

Objective:

To determine risk factors for both warfarin discontinuation and bleeding in patients with atrial fibrillation (AF).     

某三甲医院心房颤动患者华法林规范化抗凝治疗现状调查分析

目的：了解心房颤动患者抗凝治疗现状,为心房颤动规范化抗凝治疗提供参考。方法：选取皖南医学院弋矶山医院2013年1月~2014年12月非瓣膜性心房颤动患者200例,采用CHA2DS2-VASc和HAS-BLED评分系统对纳入人群进行血栓危险分层和出血风险评估,并依据《2010年欧洲心脏病学会（ESC）心房颤动治疗指南》评价其规范化抗凝情况。结果：CHA2DS2-VASc和HAS-BLED评分分别为（2.73±2.10）分和（1.57±1.13）分。183例（91.5%）患者接受抗血栓治疗,使用华法林抗凝治疗的有74例（37%）,而血栓高危组125例患者中,接受华法林抗凝治疗50例（40%）。华法林抗凝治疗时间（5.78±4.73） d,累积给药剂量为（19.46±18.19） mg,55例（74.32%）患者出院前监测国际标准化比值（INR）,INR达标率为30.9%。结论：心房颤动以华法林抗凝治疗现状不容乐观,应采取有效的干预措施,提高心房颤动患者抗凝治疗规范化程度。