华法林和阿司匹林对永久性房颤患者抗凝治疗的有效性及安全性观察(1)
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【摘要】 目的 比较华法林和阿司匹林用于永久性房颤患者抗凝治疗的有效性及安全性。方法 入选符合本研究标准的141例永久性房颤患者,随机分为两组,华法林组(治疗组)70例,以华法林2.5 mg/d作为起始剂量,阿司匹林组(对照组)71例,阿司匹林100 mg/d,早饭后即刻服用。结果 治疗组发生出血3例(4.29%),脑梗死2例(2.82%),上腹不适1例(1.43%)。对照组发生出血2例(2.82%),脑梗死13例(18.31%),上腹不适15例(21.13%)。治疗组脑梗死、上腹不适的发生率低于对照组(P<0.05),两组间出血发生率无统计学差异(P>0.05)。结论 华法林抗凝治疗可明显减少栓塞事件及上腹部不适的发生率,INR维持在2.0~3.0之间,用药既有效又安全。
【关键词】房颤; 华法林;阿司匹林;国际标准化比值(INR)
Efficacy and safety of warfarin and Aspirin in permanent atrial fibrillation
WU Rong-hui.Department of Cardiology,The State Farms Hospital of Maoming,Guangdong Province,Maoming 525200,China
【Abstract】 Objective To compared the eff icacy and safety of warfarin and aspirin in the trea-tmen t of atrial fibrillation.Methods 141 cases of patients with permanent atrial fibrillation were divid-ed in to warfarin group(n=70)and aspirin group(n=71)randomly.Warfarin group received warfarin 2.5 mg per day,Adjust the dose according to INR,each dosage 0.5 mg,keep the INR between 2.0 to 3.0,Asp-irin group received aspirin 100 mg per day.Follow-up period was one year.Results Hemorrhage of warfarin group and aspirin group was 4.29%and 2.82%respectively(P>0.05).Cerebral infarction of warfarin group and aspirin group was 2.82%and 18.21%respectively(P<0.05).epigastric discomfort of warfarin group and aspirin group was 1.43%and 21.13%respect ively(P<0.05).Conclusion Anti-thrombotic therapy with warfarin in the pat ients with permanent atrial fibrillation can significantly reduce the risk of Cerebral infarction and the epigastric discomfort,and it is effective and safe.
【Key words】Atrial fibrillation; Warfarin; Aspirin; INR
心房颤动(房颤)是临床上最常见的心律失常,并且有很高的致残率和致死率[1]。我国房颤流行病学调查结果显示,我国房颤的患病率约0.8%,其中男性患病率约0.9%,女性患病率约0.7%;35岁以下人群房颤的患病率为0.1%,75岁以上为3%,80岁以上患病率可高达7.5%;且房颤患者中脑卒中的患病率达13.1%~14.7%,而非房颤人群脑卒中的患病率仅为2.36%。华法林(warfarin)能有效防治血栓栓塞病,其疗效已被世人公认[2],但由于其治疗窗口狭窄,出血风险高,影响因素多,个体差异大,很多医生望而却步,在防治血栓患者中需用数和实际使用数不足一半。本文比较使用阿司匹林及调整剂量华法林治疗永久性房颤的有效性和安全性。
1 资料与方法
1.1 一般资料 选取2004年6月至2008年8月在我院门诊及住院的永久性房颤患者,排除以下疾病:①近一年内有消化性溃疡并出血史; ②出血性脑卒中史或半年内有新发缺血性脑卒中; ③出血性疾病或血小板减少; ④近期(3个月内)有外伤、手术、心肺复苏及穿刺史。共选患者141 例,随机分为两组。华法林组(治疗组)70例,其中男41例,女29例,55~75岁,平均65.3岁,心房颤动病程(1.70 ±0.71)年;阿司匹林组(对照组)71例,其中男42例,女29例,55~75岁,平均年龄64 ......
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