房颤患者华法林抗凝治疗177例

目的回顾性分析心房颤动（房颤）患者的抗凝治疗与卒中情况。 方法调查2015年8月1日至2017年6月30日苏北人民医院住院房颤患者301例的病例资料，记录性别、年龄、主要诊断、合并疾病情况、CHA2DS2-VASc评分、HAS-BLED评分、INR值、华法林剂量、新型口服抗凝剂（NOAC）、阿司匹林使用情况、血栓栓塞事件、出血事件情况，分析抗凝治疗的规范性及其与临床后果的关系。 结果住院房颤患者平均年龄（72±11）岁，房颤类型以非瓣膜型房颤为主，占93.7%（282/301），58.8%的房颤患者采用口服华法林抗凝治疗，4%接受NOAC抗凝治疗。华法林抗凝治疗组缺血性卒中发生率显著低于未抗凝治疗组差异具有统计学意义（13.0% vs 20.5%，P=0.025）。瓣膜型和非瓣膜型房颤患者华法林抗凝治疗后INR达标（INR 2.0~3.0）的比率分别为15.8%和7.1%。 结论为了达到更好的房颤患者卒中预防效果，需进一步加强华法林抗凝治疗的教育和监测。

Anticoagulation with warfarin in patients with atrial fibrillation: analysis of 177 cases

ObjectiveTo promote the use and monitoring of warfarin by analyzing this oral anticoagulation therapy and the occurrence of ischemic stroke in atrial fibrillation (AF) patients. MethodsWe studied 301 patients with atrial fibrillation who were hospitalized and had the information about sex, age, main diagnosis, combined disease, CHA2DS2-VASc score, HAS-BLED score, INR, the dose of warfarin, thromboembolism complications, and hemorrhagic events. We performed a study in order to understand the relationship between anticoagulation therapy and clinical outcome. ResultsThe average age of AF patients was 72±11 years. The major type is non-valvular atrial AF (93.7% vs 6.3%). Among all the cases, the proportion of patients who took warfarin for anticoagulation therapy was 58.8%, and the percentage of patients who took new oral anticoagulant (NOAC) was 4%. The incidence of ischemic stroke was significantly lower in patients with warfarin therapy (P=0.025). The percentages of patients with an INR of 2.0 to 3.0 were merely 15.8% and 7.1%, respectively, in valvular and non-valvular atrial AF patients during warfarin therapy. ConclusionTo achieve optimal result of anticoagulation in patients with atrial fibrillation, the monitoring and education of warfarin therapy should be further strengthened.