CAJ | 학술논문

目的观察老年非瓣膜性心房颤动患者超低强度华法林的抗栓疗效和安全性。方法37例年龄≥80岁、HAS- BLED出血风险积分≥3分的老年非瓣膜性心房颤动患者行华法林治疗。控制国际标准化比值在1.4~1.9（超低强度组）和2.0~2.5（低强度组）。随访12个月，观察缺血性脑卒中发生率和出血性合并症。结果超低强度和低强度组脑卒中CHA2DS2- VASc危险评分分别为（3.50±0.89）、（3.40±0.97）分，差异无统计学意义（P＞0.05）；HAS- BLED出血评分分别为（4.70±0.98）、（5.10±0.93）分，差异无统计学意义（P＞0.05）。超低强度和低强度组脑卒中发生率分别为5.0%、5.8%（P＞0.05）；严重出血发生率分别为0、5.9%，轻微出血发生率分别为10.0%、23.6%（P＜0.05）。结论对于高龄非瓣膜性心房颤动患者，华法林超低强度与低强度抗凝预防脑卒中疗效相近，但出血并发症少。
목적관찰노년비판막성심방전동환자초저강도화법림적항전료효화안전성。방법37례년령≥80세、HAS- BLED출혈풍험적분≥3분적노년비판막성심방전동환자행화법림치료。공제국제표준화비치재1.4~1.9（초저강도조）화2.0~2.5（저강도조）。수방12개월，관찰결혈성뇌졸중발생솔화출혈성합병증。결과초저강도화저강도조뇌졸중CHA2DS2- VASc위험평분분별위（3.50±0.89）、（3.40±0.97）분，차이무통계학의의（P＞0.05）；HAS- BLED출혈평분분별위（4.70±0.98）、（5.10±0.93）분，차이무통계학의의（P＞0.05）。초저강도화저강도조뇌졸중발생솔분별위5.0%、5.8%（P＞0.05）；엄중출혈발생솔분별위0、5.9%，경미출혈발생솔분별위10.0%、23.6%（P＜0.05）。결론대우고령비판막성심방전동환자，화법림초저강도여저강도항응예방뇌졸중료효상근，단출혈병발증소。
Objective To investigate the effect and safety of warfarin anticoagulation in ultra- low intensity in octogenarians with nonvalvular atrial fibril ation (NVAF). Methods 37 NVAF patients aged ≥80 years old and with HAS- BLED score≥3 were treated with warfarin. International normalized ratio was control ed to a range of 1.4 to 1.9 in ultra- low intensity group (ULI group) and 2.0 to 2.5 in low intensity group (LI group). Al patients were fol owed up for 12 months.The ischemic stroke and bleeding events were assessed. Results CHA2DS2- VASc and HAS- BLED scores were similar between ULI and LI group[(3.50±0.89)vs.(3.40±0.97), (4.70±0.98)vs.(5.10±0.93),respectively] . The incidence of ischemic stroke was similar in ULI and LI group (5.0% vs. 5.8%, P >0.05), while the severe and mild bleeding was significantly more frequent in LI group (5.9%and 23.6% )than ULI group ( 0 and 10%)(P<0.05). Conclusion Warfarin anticoagulation in ultra- low intensity has similar effect as that in low intensity on prevention of stroke in octogenarians with NVAF, but with lower bleeding risk.