华法林快速抗凝方案在脑梗死合并房颤患者中的应用价值

Applied Worth Study of Rapid Anticoagulation Protocol in Ischemic Stroke with Atrial Fibrillation

关键词:  非瓣膜病性心房颤动  脑梗死  华法林  快速抗凝方案

Key words:  none valvular atrial fibrillation  ischemic stroke  warfarin  rapid anticoagulation protocol

摘要:

目的 探索华法林快速抗凝方案在中国急性脑梗死合并非瓣膜病性心房颤动患者中的应用价值。方法 2013年1月-2016年2月间急性脑梗死合并非瓣膜病性房颤患者101例，采用前瞻性开放研究，将其分为快速抗凝组和常规抗凝组。快速抗凝组的华法林初始剂量为3~4.5 mg，随后按流程每日调整剂量至INR稳定达标；常规抗凝组的初始剂量为1~3 mg，随后根据对患者的风险与获益评估调整华法林剂量。主要终点是比较2组间的INR稳定达标率、达标时间和安全性。结果 至1周、2周和1月时，快速抗凝组INR稳定达标率均显著高于常规抗凝组（48.2% vs 4.4%，P=0.000；91.1% vs 40.0%，P=0.000；96.4% vs 48.9%，P=0.000）、INR稳定达标时间分别为（8.3±2.9） d和（13.2±4.5） d（P=0.000）。随访至1年，快速抗凝组的INR稳定达标率为54.5%（30/55），而常规抗凝组仅为31.8%（14/44），2组具有显著性差异（P<0.05）。在安全性方面，快速抗凝组与常规抗凝组2周内INR ≥ 4的患者比例分别为5.4%（3/56）和6.7%（3/45）。结论 华法林快速抗凝治疗比常规抗凝不仅更安全有效，而且显著增加了患者的依从性，值得借鉴。

Abstract:

OBJECTIVE To investigate the applied worth of rapid anticoagulation protocol in acute ischemic stroke with none valvular atrial fibrillation (NVAF) in China. METHODS Selected 101 patients with acute ischemic stroke and NVAF from January 2013 to February 2016. They were openly divided into rapid anticoagulation group and empirical anticoagulation group. The initial dose of warfarin was 3-4.5 mg in rapid anticoagulation group. Then the dose adjustment in everyday was followed by a novel protocol. The initial dose of warfarin was 1-3 mg in empirical group. Then the dose adjustment was followed by doctors assessment of patient's risk and benefit. RESULTS The rate of patients reaching a stable INR in rapid anticoagulation group was significantly higher than in empirical group in 1 week, 2 weeks and 1 month after began anticoagulation (48.2% vs 4.4%, P=0.000; 91.1% vs 40.0%, P=0.000; 96.4% vs 48.9%, P=0.000). Time to stable warfarin dosing in rapid group was shorter than empirical group[(8.3±2.9)d vs (13.2±4.5)d, P=0.000]. The rate of patients reaching a stable INR after one year in rapid anticoagulation group was also significantly higher than in empirical group(54.5% vs 31.8%, P<0.05). The rate of INR>4 at 2 weeks was 5.4%(3/56) in rapid anticoagulation group and 6.7%(3/45) in empirical group. CONCLUSION Rapid anticoagulation protocol is more effective and safe than empirical anticoagulation group. What is more, rapid anticoagulation protocol improves NVAF patients' compliance. So rapid anticoagulation protocol has an extensive application value in China.