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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/OL]. 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/OL]. 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(%)]
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