华法林用于各卒中风险非瓣膜性房颤患者对其血栓栓塞与出血风险的影响

目的分析非瓣膜性房颤住院患者使用华法林进行抗凝治疗和国际标准化比值(INR)监测状况,以期更好地指导临床抗凝治疗,减少抗凝治疗中血栓栓塞和出血事件发生。方法收集2017年6-12月汕头大学医学院第一附属医院住院治疗的非瓣膜性房颤患者的临床资料、用药情况,监测患者住院期间INR值。采用CHA2DS2-VASc评分对所有患者进行卒中风险评估。随访2年,观察患者因血栓栓塞事件、出血事件再入院情况。结果本研究共纳入病例662例,其中144例使用华法林。在CHA2DS2-VASc评分分层中,中、高危卒中风险患者服用华法林组的INR处于1.5~2.5区间的比例高于无服用组(P<0.05)。在140例服用华法林且INR数据完整患者中,63例(45.0%)INR处于1.0~1.5区间,仅29例(20.7%)INR处于2.0~3.0区间;高危卒中风险患者INR在1.5~2.0组发生血栓栓塞、出血事件再次住院的比例低于INR非1.5~2.0组(P<0.05)。结论临床上华法林使用率低,抗凝强度低。对于中、高危卒中风险患者来说,正确服用华法林有助于将INR控制在1.5~2.5区间。当高危卒中患者的INR处于1.5~2.0区间时可减少血栓栓塞、出血风险的发生。

Effect of warfarin on the risk of thromboembolism and bleeding in patients with non-valvular atrial fibrillation at various stroke risks

Objective To analyses warfarin usage and international normalized ratio(INR)data in non-valvular atrial fibrillation(NVAF)inpatients,in terms of further clinical suggestion and reduction of thromboembolism or bleeding events in anticoagulant therapy.Methods Clinical data,medication and INR data during hospitalization of patients with NVAF were collected.These patients hospitalized in the First Affiliated Hospital of Shantou University Medical College from June 2017 to December 2017.Results A total of 662 cases were included in this study,of which 144 used warfarin.In the CHA2 DS2-VASc score stratification,the percentage of INR between 1.5 and 2.5 in warfarin group was higher than that in the no-take group(P<0.05)at medium and high risk of stroke stratifications.Of the 140 patients who took warfarin with completed INR data,there are 63 cases(45.0%)with INR between 1.0 and 1.5,while only 29 cases(20.7%)with INR between 2.0 and3.0.In the high-risk stroke risk stratification,the proportion of patients with INR between 1.5 and 2.0 who were readmission for thromboembolism and bleeding events was lower than the group without INR between 1.5 and 2.0.Conclusion The clinical use rate of warfarin and the anticoagulant intensity are both low.For medium and high stroke risk patients,the correct administration of warfarin helps to keep INR within a range of 1.5~2.5.When the INR of high-risk stroke patients is controlled in the range of 1.5~2.0,the risk of thromboembolism and bleeding can be reduced.