CAJ | 학술논문

目的：应用2010年欧洲心脏病学协会（ESC）房颤新指南提出的新的评分系统卒中危险评分（CHA2DS2-VASc）和首次推出的出血风险评分法（HAS-BLED），观察CHA2DS2-VASc积分≥1分且HAS-BLED出血风险积分≥3分时，低强度华法林抗凝治疗高出血风险房颤患者的抗栓疗效和安全性。方法2011年1月至2012年1月我院非瓣膜性房颤患者99例，其CHA2DS2-VASc卒中危险评分≥1分且HAS-BLED出血风险积分≥3分。全部病例分成两组，标准强度华法林治疗组[2.0＜国际标准化比值（INR）≤3.0]和低强度华法林治疗组（1.6≤INR≤2.0）。观察两组患者的血栓栓塞率及出血发生率。结果卡方检验结果显示，两组患者的血栓栓塞率差异无统计学意义（P＞0.05）；标准强度华法林治疗组的出血发生率高于低强度华法林治疗组患者，差异有统计学意义（P＜0.05）。结论 CHA2DS2-VASc卒中危险评分≥1分且HAS-BLED出血风险积分≥3分的高出血风险的房颤患者可以采用低强度华法林抗凝，能有效减少血栓栓塞事件的发生，同时不增加严重出血事件，使用安全可靠。
목적：응용2010년구주심장병학협회（ESC）방전신지남제출적신적평분계통졸중위험평분（CHA2DS2-VASc）화수차추출적출혈풍험평분법（HAS-BLED），관찰CHA2DS2-VASc적분≥1분차HAS-BLED출혈풍험적분≥3분시，저강도화법림항응치료고출혈풍험방전환자적항전료효화안전성。방법2011년1월지2012년1월아원비판막성방전환자99례，기CHA2DS2-VASc졸중위험평분≥1분차HAS-BLED출혈풍험적분≥3분。전부병례분성량조，표준강도화법림치료조[2.0＜국제표준화비치（INR）≤3.0]화저강도화법림치료조（1.6≤INR≤2.0）。관찰량조환자적혈전전새솔급출혈발생솔。결과잡방검험결과현시，량조환자적혈전전새솔차이무통계학의의（P＞0.05）；표준강도화법림치료조적출혈발생솔고우저강도화법림치료조환자，차이유통계학의의（P＜0.05）。결론 CHA2DS2-VASc졸중위험평분≥1분차HAS-BLED출혈풍험적분≥3분적고출혈풍험적방전환자가이채용저강도화법림항응，능유효감소혈전전새사건적발생，동시불증가엄중출혈사건，사용안전가고。
Objective To determine the safety and availability of anticoagulation of low-intensity warfarin therapy in atrial fibrillation (AF) patients with high risk of stroke and bleeding applying stroke risk score (CHA2DS2-VASc) and bleeding risk score (HAS-BLED) (CHA2DS2-VASc≥1 and HAS-BLED≥3) proposed by 2010 European Society of Cardiology Guideline. Methods A total of 99 AF patients who had the stroke risk scoring CHA2DS2-VASc≥1 and HAS-BLED score≥3 admitted in our hospital from January 2011 to January 2012 were selected randomly, and then divided into 2 groups. One group was treated by a standard intensity warfarin therapy of 2.0<International Normalized Ratio (INR)≤3.0, and the other group was given a low-intensity warfarin therapy (1.6≤INR≤2.0). The incidence of stroke and bleeding events of the two groups were compared. Results Chi-square test indicated that there was no statistical difference in the incidence of stroke and bleeding between these 2 groups (P>0.05). The incidence of bleeding was significantly higher in standard-intensity Warfarin group than in low-intensity Warfarin group (P<0.05). Conclusion AF patients with high bleeding risk (CHA2DS2-VASc≥1 and HAS-BLED score≥3) should be treated by low-intensity warfarin anticoagulation. The therapy is safe and reliable, with advantages of suppressing thrombosis and embolism events and not increasing serious hemorrhage.