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目的研究低抗凝强度的华法林治疗高龄老年非瓣膜病性永久性心房颤动(NVAF)患者血栓形成的安全性。方法入选NVAF患者按年龄分为两组:高龄老年组40例,年龄≥80岁,平均84.50±4.05岁,老年组40例,年龄60～79岁,平均74.50±4.00岁。两组采用华法林低强度抗凝,目标范围为国际标准化比值(INR)1.6～2.5。随访1年,观察两组患者用药的不良反应和华法林的安全用量范围。结果 INR在1.6～2.5时高龄老年组和老年组华法林维持剂量分别为1.25～3.75mg/d,平均2.86±0.62mg/d和1.88～3.75mg/d,平均2.66±0.12mg/d。INR在安全范围内华法林的用量两组比较无统计学差异。两组患者均未发现严重出血,高龄老年组与老年组分别发生轻度牙龈出血6例和7例、皮下淤血各3例、尿常规检查有红细胞2例和1例,粪便潜血弱阳性3例和2例;两组出血发生率差异无统计学意义(P>0.05)。两组患者均无新的血栓栓塞事件发生。结论严密监测INR下调整华法林剂量对高龄老年NVAF患者治疗的安全性好。
Objective To study the safety of low anticoagulant warfarin in the treatment of thrombosis in elderly patients with non-valvular permanent atrial fibrillation (NVAF). Methods The patients with NVAF were divided into two groups according to their ages: 40 in the elderly group, with an average age of 84.50 ± 4.05 years old and 40 in the elderly group, ranging in age from 60 to 79 years with an average of 74.50 ± 4.00 years old. Warfarin low-intensity anticoagulation was used in both groups and the target range was an International Normalized Ratio (INR) of 1.6 to 2.5. Followed up for 1 year, the two groups of patients treated with adverse reactions and warfarin safe dosage range. Results The warfarin dose was 1.25-3.75mg / d in the elderly aged group and elderly group with an INR of 1.6-2.5, with an average of 2.86 ± 0.62mg / d and 1.88-3.75mg / d, with an average of 2.66 ± 0.12mg / d. INR in the safe range of warfarin dosage was no significant difference between the two groups. No severe bleeding was found in both groups. There were 6 cases and 7 cases of mild gingival bleeding, 3 cases of subcutaneous congestion, 2 cases of red blood cells and 1 case of urine routine examination, 3 cases of fecal occult blood weakness And 2 cases. There was no significant difference in the incidence of bleeding between the two groups (P> 0.05). No new thromboembolic events occurred in both groups. Conclusions A close monitoring of the warfarin dose adjusted warfarin in elderly patients with advanced NVAF is safe.