CAJ | 학술논문

目的探讨华法林预防非瓣膜性心房颤动(NVAF)患者并发脑梗死的疗效和安全性.方法选择NVAF患者136例,按随机数字表法分为华法林组[口服华法林钠片,初始剂量为2.0mg/d,目标国际标准化比值(INR)为2.0～3.0]、阿司匹林组(口服阿司匹林100 mg/d)和对照组(未用抗栓药物).常规门诊随访,调整华法林剂量并记录三组患者的终点事件和不良反应发生情况,随访时间18个月.结果 136例患者失访4例,进入研究的132例患者中,男77例,占58.3%.华法林组口服华法林钠片的剂量为(2.5±1.0)mg.随访期间共发生主要终点事件12例,其中华法林组1例(2.50%,1/40)、阿司匹林组4例(9.52%,4/42)、对照组7例(14.00%,7/50),三组主要终点事件发生率比较差异无统计学意义(x2=2.084,P=0.353).伴随≥3种危险因素的三组之间生存曲线比较差异有统计学意义(x2=6.404,P=0.041).华法林组出血并发症发生率高于阿司匹林组[5.00%(2/40)比2.38%(1/42)],但差异无统计学意义(P＞0.05).结论伴随≥3种危险因素的NVAF患者,华法林可改善患者的生存率,华法林导致出血并发症多数发生在INR＞3.0.严密监测下(INR 2.0～3.0)的调整剂量华法林安全有效.
목적 탐토화법림예방비판막성심방전동(NVAF)환자병발뇌경사적료효화안전성.방법 선택NVAF환자136례,안수궤수자표법분위화법림조[구복화법림납편,초시제량위2.0mg/d,목표국제표준화비치(INR)위2.0～3.0]、아사필림조(구복아사필림100 mg/d)화대조조(미용항전약물).상규문진수방,조정화법림제량병기록삼조환자적종점사건화불량반응발생정황,수방시간18개월.결과 136례환자실방4례,진입연구적132례환자중,남77례,점58.3%.화법림조구복화법림납편적제량위(2.5±1.0)mg.수방기간공발생주요종점사건12례,기중화법림조1례(2.50%,1/40)、아사필림조4례(9.52%,4/42)、대조조7례(14.00%,7/50),삼조주요종점사건발생솔비교차이무통계학의의(x2=2.084,P=0.353).반수≥3충위험인소적삼조지간생존곡선비교차이유통계학의의(x2=6.404,P=0.041).화법림조출혈병발증발생솔고우아사필림조[5.00%(2/40)비2.38%(1/42)],단차이무통계학의의(P＞0.05).결론 반수≥3충위험인소적NVAF환자,화법림가개선환자적생존솔,화법림도치출혈병발증다수발생재INR＞3.0.엄밀감측하(INR 2.0～3.0)적조정제량화법림안전유효.
Objective To investigate the efficacy and safety of warfarin in the prevention of cerebral infarction in nonvalvular atrial fibrillation (NVAF). Methods One hundred and thirty-six NVAF patients were randomized into warfarin group [receiving adjusted-dose warfarin,international normalized ratio(INR)was 2.0 - 3.0], aspirin group( receiving aspirin 100 mg/d) and control group (treated without anticoagulants )by random digits table. Followed up 18 months, and the main end point events and adverse effect of the three groups were compared. Results In 136 cases,4 cases lost,and 77 cases(58.3%) were male. The mean dose of warfarin was(2.5 ± 1.0) mg. During the follow-up period, main end point events occurred in 12 cases,with 1 case (2.50%, 1/40) in warfarin group, 4 cases(9.52%, 4/42 ) in aspirin group and 7 cases ( 14.00%, 7/50)in control group. There was no significant difference in main end point events among the three groups ( x2 =2.084,P =0.353). But in the patients with 3 or above risk factors,there was significant difference in the survival curve among the three groups ( x2 = 6.404, P = 0.041 ). The incidence rate of bleeding was higher in warfarin group than that in aspirin group,but there was no significant difference [5.00%(2/40) vs. 2.38%(1/42),P ＞ 0.05]. Conclusions Warfarin can improve survival rate especially in the patients with 3 or above risk factors,and the complication of bleeding occurs mostly when INR ＞ 3.0.Under closed monitoring (INR 2.0-3.0),adjusted-dose warfarin is safety and efficacy.