不同华法林抗凝治疗强度治疗冠心病并非瓣膜性房颤的效果

目的 探讨不同华法林抗凝治疗强度治疗冠心病并非瓣膜性房颤(NVAF)的效果.方法 238例冠心病并非瓣膜性房颤患者,根据随机数字表法分为对照组(59例)、低强度组(58例)、标准强度组(65例)、高强度组(56例).对照组采取阿司匹林抗凝治疗,低强度组采用国际标准化比值(INR)1.5～2.0华法林进行抗凝治疗,标准强...

Effect of different intensities of warfarin anticoagulant therapy in the treatment of coronary heart disease with non-valvular atrial fibrillation

Objective To discuss the effect of different intensities of warfarin anticoagulant therapy in the treatment of coronary heart disease with non-valvular atrial fibrillation(NVAF).Methods A total of 238 cases of coronary heart disease with non-valvular atrial fibrillation were divided into control group(59 cases),low-intensity group(58 cases),standard-intensity group(65 cases),and high-intensity group(56 cases)according to random numerical table.The control group was treated with aspirin anticoagulation,the low-intensity group was treated with international normalized ratio(INR)1.5-2.0 warfarin for anticoagulation,the standard-intensity group was treated with INR 2.01-2.50 warfarin for anticoagulation,and the high-intensity group was treated with INR 2.51-3.00 warfarin for anticoagulation.The occurrence of embolism,severe bleeding,and total bleeding events during follow-up of the four groups were observed and compared.Results In the control group,embolism occurred in 16 cases,including 6 cases of ischemic stroke,6 cases of mesenteric artery embolism and 4 cases of pulmonary embolism;in the low-intensity group,embolisms occurred in 7 cases,including 5 cases of ischemic strokes and 2 cases of mesenteric artery embolisms;in standard-intensity group,embolism occurred in 7 cases,all of which were ischemic strokes;in the high-intensity group,embolism occurred in 1 case,which was ischemic stroke.The incidence of embolism in the control group was 27.12%,which was higher than 12.07%in the low-intensity group,10.77%in the standard-intensity group,and 1.79%in the high-intensity group,and the differences were statistically significant(P<0.05).In the high-intensity group,7 cases of severe bleeding occurred,including 1 case of cerebral bleeding and 6 cases of gastrointestinal hemorrhage;in the standard-intensity group,2 cases of severe bleeding occurred,including 1 case of cerebral hemorrhage and 1 case of gastrointestinal hemorrhage;in the low-intensity group,1 case of severe bleeding occurred,which was gastrointestinal hemorrhage.The incidence of severe bleeding in the high-intensity group was 12.50%,which was higher than 3.08%in the standardintensity group,1.72%in the low-intensity group and 0 in the control group,and the difference was statistically significant(P<0.05).The total incidence of bleeding in the control group,low-intensity group,standard-intensity group,and high-intensity group were 5.08%,10.34%,12.31%,and 12.50%.Conclusion Warfarin anticoagulant therapy has obvious effect in the treatment of coronary heart disease with non-valvular atrial fibrillation,and can effectively prevent embolism.The higher the intensity of INR,the better the prevention effect of embolism,but high intensity is easy to lead to the risk of severe bleeding,INR 1.5-2.5 has obvious effect,high safety and higher clinical application value.