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中华临床医师杂志(电子版) ›› 2018, Vol. 12 ›› Issue (09) : 508 -511. doi: 10.3877/cma.j.issn.1674-0785.2018.09.006

所属专题: 文献

临床研究

房颤患者华法林抗凝治疗177例
严凤娣1, 梅宏斌2, 纪军2, 徐冰2, 张晶2, 陈述2, 何胜虎2,()   
  1. 1. 225001 扬州,江苏省苏北人民医院重症医学科
    2. 225001 扬州,江苏省苏北人民医院心内科
  • 收稿日期:2018-04-07 出版日期:2018-05-01
  • 通信作者: 何胜虎

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

Fengdi Yan1, Hongbin Mei2, Jun Ji2, Bing Xu2, Jing Zhang2, Shu Chen2, Shenghu He2,()   

  1. 1. Department of Critical Care Medicine, Northern Jiangsu People′s Hospital, Yangzhou 225001, China
    2. Department of Cardiology, Northern Jiangsu People′s Hospital, Yangzhou 225001, China
  • Received:2018-04-07 Published:2018-05-01
  • Corresponding author: Shenghu He
  • About author:
    Corresponding author: He Shenghu, Email:
引用本文:

严凤娣, 梅宏斌, 纪军, 徐冰, 张晶, 陈述, 何胜虎. 房颤患者华法林抗凝治疗177例[J]. 中华临床医师杂志(电子版), 2018, 12(09): 508-511.

Fengdi Yan, Hongbin Mei, Jun Ji, Bing Xu, Jing Zhang, Shu Chen, Shenghu He. Anticoagulation with warfarin in patients with atrial fibrillation: analysis of 177 cases[J]. Chinese Journal of Clinicians(Electronic Edition), 2018, 12(09): 508-511.

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。

Objective

To promote the use and monitoring of warfarin by analyzing this oral anticoagulation therapy and the occurrence of ischemic stroke in atrial fibrillation (AF) patients.

Methods

We 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.

Results

The 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.

Conclusion

To achieve optimal result of anticoagulation in patients with atrial fibrillation, the monitoring and education of warfarin therapy should be further strengthened.

表1 口服华法林患者与未进行抗凝治疗患者一般临床资料比较
表2 非瓣膜性房颤患者的抗凝情况CHA2DS2-VASC评分(男性/女性)
表3 房颤患者INR情况[例数(%)]
表4 不同治疗组缺血性卒中/TIA事件发生率比较[例数(%)]
1
胡大一,孙艺红,周自强, 等.中国人非瓣膜性心房颤动脑卒中危险因素的病例-对照研究[J]. 中华内科杂志, 2003, 42(3):157-161.
2
Chern-En Chiang, Ken Okumura, Shu Zhang, et al. 2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation[J]. J Arrhythm, 2017, 33(4):345-367.
3
周自强,胡大一,陈捷, 等. 中国心房颤动现状的流行病学研究[J]. 中华内科杂志, 2004, 43(7):491-494.
4
Hu D, Sun Y. Epidemiology, risk factors for stroke, and management of atrial fibrillation in China[J]. J Am Coll Cardiol, 2008, 52(10):865-868.
5
Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation[J]. Ann Intern Med, 2007, 146(12):857-867.
6
Freedman B, Potpara TS, Lip GYH. Stroke prevention in atrial fibrillation[J]. Lancet, 2016, 388(10046):806-817.
7
Gladstone DJ, Bui E, Fang J, et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated[J]. Stroke, 2009, 40:235-240.
8
Tomita H, Hagii J, Metoki N, et al. Impact of sex difference on severity and functional outcome in patients with cardioembolic stroke[J]. J Stroke Cerebrovasc Dis, 2015, 24:2613-2618.
9
Perera KS, Vanassche T, Bosch J, et al. Global survey of the frequency of atrial fibrillation–associated stroke. Embolic stroke of undetermined source global registry[J]. Stroke, 2016, 47:2197-2202.
10
Levine MN, Raskob G, Landefeld S, et al. Hemorrhagic complications of anticoagulant treatment[J] .Chest, 2001 , 119(1Suppl):108S-121S .
11
胡大一,苏艺红. 心房颤动的流行病学和治疗现状[J]. 中华全科医师杂志, 2006, 5(1):5-7.
12
Hu D, Sun Y. Epidemiology, risk factors for stroke, and management of atrial fibrillation in China[J]. J Am Coll Cardiol, 2008, 52(10):865-868.
13
Ridker PM, Goldhaber SZ, Danielson E, et al. Long-term, low intensity warfarin therapy for the prevention of reccurrent venous thromboembolism[J]. N Engl J Med, 2003, 348:1425-1434 .
14
中华医学会心血管病学分会,中国老年学学会心脑血管病专业委员会. 华法林抗凝治疗的中国专家共识[J]. 中华内科杂志, 2013, 25(1):76-82.
15
Gallagher AM, Setakis E, Plumb JM, et al. Risks of strokeand mortality associated with suboptimal anticoagulation in atrial fibrillation patients[J]. Thromb Haemost, 2011, 106(5):968-977.
16
心房颤动杭检研究协作组. 华法林对非瓣膜病心房颤动抗栓的安全性和有效性研究[J]. 中华内科杂志, 2016, 45(10):800-803.
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