非瓣膜病性心房纤颤及其合并脑栓塞患者的抗凝治疗
发布时间：2018-10-31 18:38
【摘要】：目的探讨非瓣膜病性心房纤颤(房颤)及其合并脑栓塞患者的抗凝治疗情况。方法采集2012年1月~2013年12月于苏州大学附属第二医院治疗的208例心源性脑栓塞患者的临床资料,对其中存活的164例非瓣膜病性房颤(包括华法林抗凝治疗34例,抗血小板治疗130例)以及另行采集的36例一级预防华法林抗凝治疗的非瓣膜病性房颤患者随访1年。分析70例华法林抗凝治疗患者的基本情况,并依据预防等级、年龄、国际标准化比值(INR)控制水平、1年内是否继发出血进行分组比较,并分析与稳态时华法林剂量相关的因素。结果 164例非瓣膜病性房颤合并脑栓塞患者中,华法林抗凝组患者年龄、入院NIHSS评分明显低于抗血小板组,INR、1年内颅内外出血发生率明显高于抗血小板组(均P0.05)。70例抗凝治疗患者中,与二级预防相比,一级预防的患者年龄、房颤患者口服抗凝药物出血评分(HAS-BLED评分)和1年停用华法林的比例明显降低,身高、体质量和华法林初始剂量明显增高(均P0.05);与65岁的患者相比,≥65岁患者的房颤患者脑卒中风险评分和HAS-BLED评分明显增高,华法林初始剂量和稳态华法林剂量明显降低(均P0.05);INR 1.5~2.0的与INR 2.1~3.0的患者临床资料比较,差异均无统计学意义(均P0.05);与1年内未继发出血的患者比较,1年内继发出血的患者入院NIHSS评分明显增高,初始INR水平明显降低(均P0.05)。稳态时华法林剂量与年龄呈负相关,与初始华法林剂量呈正相关(均P0.05)。结论对于非瓣膜病性房颤合并脑栓塞患者而言,华法林抗凝治疗较抗血小板治疗的出血风险高。对于华法林抗凝治疗的非瓣膜病性房颤患者而言,一级预防较二级预防的患者年龄更轻、服药依从性好;低抗凝强度(INR 1.5~2.0)与传统抗凝强度(INR 2.1~3.0)在降低脑卒中发生率、出血风险方面无明显差别;年龄较轻患者华法林初始剂量及稳态时剂量均较高,但脑卒中风险及出血风险较低。
[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，
本文编号：2303186
[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，
本文编号：2303186
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