刘洪军　张卫红　代旻升

[摘要] 目的 觀察低抗凝强度华法林对非瓣膜病性心房纤颤的抗栓疗效。 方法 选取2015年1月～2016 年1月收治的120例非瓣膜性心房纤颤患者，所有患者随机分为三组，每组各40例，研究组A组予以常规抗凝强度INR 2.0～3.0的华法林，研究组B组为低抗凝强度（INR为1.5～2.1），对照组予肠溶阿司匹林。比较分析各组脑卒中、下肢深静脉血栓、肺栓塞的发生率，随访6个月，比较各组出血的发生率，包括皮肤出血、牙龈出血、消化道出血。结果 研究组A、研究组B的脑卒中发生率分别为10.0%、12.5%，分别显著低于对照组的30.0%，组间比较，差异有统计学意义（P<0.05）。但研究组A、研究组B的脑卒中发生率组间比较，差异无统计学意义（P>0.05），且三组下肢深静脉血栓、肺栓塞的发生率组间比较，差异无统计学意义（P>0.05）。研究组A、研究组B的出血发生率分别为17.5%、5.0%，分别显著低于对照组的35.0%，组间比较，差异具有统计学意义（P<0.05）。且研究组B的出血发生率为5.0%，显著低于研究组A的出血发生率17.5%（P<0.05）。 结论 低抗凝强度华法林对非瓣膜性心房纤颤的抗栓疗效确切，出血率低，安全性好，值得广泛推广和应用。

[关键词] 非瓣膜病性心房纤颤；华法林；低抗凝强度；抗栓

[中图分类号] R541.75 [文献标识码] B [文章编号] 1673-9701（2017）26-0037-03

Antithrombotic effect of warfarin with low anticoagulant strength on nonvalvular atrial fibrillation

LIU Hongjun ZHANG Weihong DAI Minsheng

Department of Cardiology， Changle County People's Hospital of Shandong Province， Changle 262400， China

[Abstract] Objective To observe the antithrombotic effect of warfarin with low anticoagulant strength on nonvalvular atrial fibrillation. Methods A total of 120 patients with nonvalvular atrial fibrillation from January 2015 to January 2016 were selected. All patients were randomly divided into three groups with 40 patients in each group. Study group A was given warfarin with conventional anticoagulant intensity INR 2.0-3.0. Study group B was treated with low anticoagulant intensity（INR=1.5-2.1） warfarin. And the control group was treated with enteric-coated aspirin. The incidence of stroke， lower limb deep vein thrombosis and pulmonary embolism were compared between the groups. The patients were followed up for 6 months. The incidence of hemorrhage including skin bleeding， gingival bleeding and gastrointestinal bleeding between the groups were compared. Results The incidence of stroke in study group A and study group B was 10.0% and 12.5% respectively， which was significantly lower than that in control group（30.0%）， and there was significant difference among the two groups（P<0.05）. There was no significant difference in the incidence of stroke between the study group A and study group B（P>0.05）. And there was no significant difference in the incidence of lower limb deep vein thrombosis and pulmonary embolism among the three groups （P>0.05）. The incidence of bleeding in study group A and study group B was 17.5% and 5.0%， respectively， which was significantly lower than that in control group（35.0%）， and there was significant difference among the groups（P<0.05）. The incidence of bleeding in study group B was 5.0%， which was significantly lower than that in study group A （17.5%， P<0.05）. Conclusion Low anticoagulant strength warfarinis effective in the treatment of nonvalvular atrial fibrillation， and the bleeding rate is low， with good safety， which is worthy of widely promotion and application.endprint

[Key words] Nonvalvular atrial fibrillation； Warfarin； Low anticoagulant strength； Antithrombosis

心房纤颤是老年患者最常见的心律失常之一，心房颤动导致的最大危害是引起血流动力学改变，导致血栓栓塞，其中以缺血性脑卒中影响最大。研究报道显示，国内房颤患者脑卒中的发生率已达30%[1]，且随年龄增长而增加，严重威胁患者的生命健康。有效的抗栓治疗可以预防房颤并发血栓栓塞的发生。华法林和阿司匹林为临床常用的抗凝药物，在临床应用中发现，华法林有严重出血的不良反应[2]，必须严密监测反映其抗凝强度的国际标准化比值（international normalized ratio，INR），INR的合理范围能保证华法林有效的抗凝强度和最大的安全性[3]。但目……