摘要
目的评估华法林不同抗凝强度治疗非瓣膜性房颤的安全性,以及缺血性脑卒中发生的危险因素。方法纳入2012年1月—2013年12月收治的130例非瓣膜性房颤患者,根据华法林抗凝治疗的强度分为中强度组：华法林中等强度抗凝治疗,国际标准化比率（international normalized ratio,INR）控制在2.00.05）;中强度组华法林用量（3.13±0.45）mg·d^-1,INR值2.61±0.32,出血发生率为24.14%;低强度组华法林用量（2.63±0.32）mg·d^-1,INR值1.84±0.30,出血发生率为9.72%。采用INR诊断患者出血风险,ROC曲线下面积为0.858（95%CI：0.791~0.924）,INR的cut-off值2.85,该值下判断出血敏感性为81.1%,特异性为67.2%;多因素Logistic回归分析发现年龄、合并高血压、糖尿病、心力衰竭、脑卒中病史、INR、治疗窗内时间、卒中危险评分是非瓣膜性房颤患者缺血性脑卒中发生的独立危险因素（P〈0.05）。结论中、低强度华法林抗凝治疗均有较好的抗凝效果,非瓣膜性心房颤动患者伴有血栓栓塞危险因素应尽早应用华法林抗凝治疗,严密监测INR,INR值控制在1.6≤INR≤2.0,降低和避免出血并发症。
OBJECTIVE To evaluate the safety and efficacy of different doses of warfarin anticoagulation therapy in non-valvular atrial fibrillation, and risk factors associated with ischemic stroke. METHODS A total of 130 patients with non-valvular atrial fibrillation from January 2012 to December 2013 were selected. Patients were divided into group A with moderate intensity warfarin anticoagulation, international normalized ratio（INR） was controlled at 2.0 to 3.0, group B with low intensity warfarin anticoagulation, INR was controlled in the 1.6 to 2.0. Adverse reactions and ischemic stroke risk in two groups of patients were recorded during follow-up. INR in diagnosis of anticoagulant bleeding risk was analyzed by using ROC curve. Risk factors associated with ischemic stroke were analyzed by multivariate Logistic regression analysis. RESULTS The ischemic stroke, transient ischemic attack, peripheral arterial embolism incidence in group A was 6.70%, 3.45%, 1.72%, while it was 8.33%, 4.17%, 4.17% in the group B, the difference was not statistically significance（P〈0.05）. The dosage of warfarin, INR value and the incidence of bleeding in group A were（3.13±0.45）mg·d^-1,（2.61±0.32）, and 24.14%, respectively, and The dosage of warfarin, INR value and the incidence of bleeding in group B were（2.63±0.32）mg·d^-1（1.84±0.30） and 9.72% respectively. the area under the ROC curve was 0.858（95%CI： 0.791-0.924）, INR＇s cut-off value was 2.85, sensitive and specificity in this value judgment of bleeding risk was 81.1% and 67.2%. Multivariate logistic regression analysis showed that age, hypertension, diabetes, heart failure, history of stroke, INR, TTR（time in therapeutic range）, stroke risk score were independent risk factors in patients with non-valvular atrial fibrillation occurrence of ischemic stroke（P〈0.05）. CONCLUSION Warfarin at low or moderate doses can both prevent ischemic stroke in patients with non-valvular atrial fibrillation, and patients with risk factors associated with ischemic stroke should be treated with warfarin as early as possible. Monitoring of INR is effective to prevent possible bleeding.
出处
《中国现代应用药学》
CAS
CSCD
2016年第6期818-822,共5页
Chinese Journal of Modern Applied Pharmacy
