發(fā)布時間：2018-10-31 18:38

【摘要】：目的探討非瓣膜病性心房纖顫(房顫)及其合并腦栓塞患者的抗凝治療情況。方法采集2012年1月~2013年12月于蘇州大學附屬第二醫(yī)院治療的208例心源性腦栓塞患者的臨床資料,對其中存活的164例非瓣膜病性房顫(包括華法林抗凝治療34例,抗血小板治療130例)以及另行采集的36例一級預(yù)防華法林抗凝治療的非瓣膜病性房顫患者隨訪1年。分析70例華法林抗凝治療患者的基本情況,并依據(jù)預(yù)防等級、年齡、國際標準化比值(INR)控制水平、1年內(nèi)是否繼發(fā)出血進行分組比較,并分析與穩(wěn)態(tài)時華法林劑量相關(guān)的因素。結(jié)果 164例非瓣膜病性房顫合并腦栓塞患者中,華法林抗凝組患者年齡、入院NIHSS評分明顯低于抗血小板組,INR、1年內(nèi)顱內(nèi)外出血發(fā)生率明顯高于抗血小板組(均P0.05)。70例抗凝治療患者中,與二級預(yù)防相比,一級預(yù)防的患者年齡、房顫患者口服抗凝藥物出血評分(HAS-BLED評分)和1年停用華法林的比例明顯降低,身高、體質(zhì)量和華法林初始劑量明顯增高(均P0.05);與65歲的患者相比,≥65歲患者的房顫患者腦卒中風險評分和HAS-BLED評分明顯增高,華法林初始劑量和穩(wěn)態(tài)華法林劑量明顯降低(均P0.05);INR 1.5~2.0的與INR 2.1~3.0的患者臨床資料比較,差異均無統(tǒng)計學意義(均P0.05);與1年內(nèi)未繼發(fā)出血的患者比較,1年內(nèi)繼發(fā)出血的患者入院NIHSS評分明顯增高,初始INR水平明顯降低(均P0.05)。穩(wěn)態(tài)時華法林劑量與年齡呈負相關(guān),與初始華法林劑量呈正相關(guān)(均P0.05)。結(jié)論對于非瓣膜病性房顫合并腦栓塞患者而言,華法林抗凝治療較抗血小板治療的出血風險高。對于華法林抗凝治療的非瓣膜病性房顫患者而言,一級預(yù)防較二級預(yù)防的患者年齡更輕、服藥依從性好;低抗凝強度(INR 1.5~2.0)與傳統(tǒng)抗凝強度(INR 2.1~3.0)在降低腦卒中發(fā)生率、出血風險方面無明顯差別;年齡較輕患者華法林初始劑量及穩(wěn)態(tài)時劑量均較高,但腦卒中風險及出血風險較低。
[Abstract]:Objective to investigate the anticoagulant treatment of non-valvular atrial fibrillation (AF) and its associated cerebral embolism. Methods from January 2012 to December 2013, 208 patients with cardiogenic cerebral embolism treated in the second affiliated Hospital of Suzhou University were collected. 164 patients with non-valvular atrial fibrillation (including 34 patients treated with warfarin anticoagulant therapy) were enrolled in this study. 130 patients with antiplatelet therapy) and 36 patients with nonvalvular atrial fibrillation treated with warfarin anticoagulant therapy were followed up for one year. 70 cases of warfarin anticoagulant therapy were analyzed and compared according to the level of prevention, age, international standardized ratio (INR) control, and whether there was secondary hemorrhage within one year. The factors related to warfarin dose at steady state were analyzed. Results among 164 patients with non-valvular atrial fibrillation complicated with cerebral embolism, warfarin anticoagulant group had significantly lower admission NIHSS score than anti-platelet group, and INR, was significantly lower than that in warfarin anticoagulant group. The incidence of extracranial hemorrhage in one year was significantly higher than that in anti-platelet group (P0.05). In 70 patients with anticoagulant therapy, the age of primary prevention was higher than that of secondary prevention. The rate of oral anticoagulant bleeding score (HAS-BLED score) and one year withdrawal of warfarin in patients with atrial fibrillation were significantly decreased, height, body mass and initial dose of warfarin were significantly increased (P0.05). Compared with 65 years old patients, the stroke risk score and HAS-BLED score in patients with atrial fibrillation 鈮，

本文編號：2303186