房颤患者华法林初始剂量及出血危险因素的调查分析

目的: 比较两种华法林初始剂量在房颤患者中应用的安全性及有效性,并探讨其出血相关危险因素。方法: 采用回顾性调查方法,将某医院服用华法林的住院房颤患者按初始剂量分为超低剂量组(1.25~1.875 mg)和低剂量组(2.5~3.0 mg),比较两组患者抗凝的安全性和有效性指标。同时采用Logistic回归分析主要的出血危险因素。结果: 超低剂量患者各项安全性指标与低剂量组均无统计学差异(P>0.05);但前者首次达到目标国际标准化比值(INR)的时间较后者显著延长(P＜0.05),同时INR低于目标范围的比例显著增加且INR的控制率显著降低(P＜0.001)。年龄>65岁,肝功能不全,出血体质,卒中史,联用胺碘酮会显著增加华法林的出血风险(OR>1且P<0.05)。结论: 房颤患者应用超低初始剂量华法林抗凝的出血风险与低初始剂量相当但血栓风险增加;对于联用胺碘酮的患者,应加强出血风险的监护。

Investigation and analysis on initial warfarin dosage and hemorrhagic risk factors for atrial fibrillation

AIM: To compare the therapeutic efficacy and safety of two initial warfarin doses for atrial fibrillation(AF) and to further study the risk factors of hemorrhage.METHODS: A retrospective study was adopted. The inpatients with AF in recent 2 years were divided into two groups according to their initial warfarin doses: ultra-low dose group(1.25-1.875 mg) and low dose group (2.5-3.0 mg). The efficacy and safety of initial therapy of two groups were compared. Meanwhile, the major risk factors of bleeding were analyzed with logistic regression.RESULTS: There was no significant difference between two groups with respect to the safety (P>0.05).However, the mean time to reach a therapeutic INR was significantly longer in the ultra-low dose group than that of low dose group (P＜0.05). In addition, the proportion of INR below the therapeutic range was much higher and the proportion of INR within the therapeutic range was much lower in ultra-low dose group than that of low dose group (P＜0.001). Elderly (age>65 years), abnormal liver function, bleeding, stroke and amiodarone may increase the risk of hemorrhage significantly (OR>1,P<0.05).CONCLUSION: In the patients with AF, the ultra-low initial dosage has equal safety with regard to hemorrhage but increases the risk of thrombosis.At the same time,monitoring of the patients who combined amiodarone should be strengthened.