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目的:观察超高龄房颤患者采用不同强度华法林抗凝后的心血管不良事件发生情况,探讨此类患者国际标准化比值(international normalized ratio,INR)的合理范围,为临床提供依据。方法:将108例超高龄房颤患者(年龄≥80岁)按INR值分为中等强度抗凝组(56例)和低等强度抗凝组(52例);低等强度抗凝组的INR维持在1.40~1.80;中等强度抗凝组的INR维持在1.81~2.50。随访(1.8±1.2)年,观察发生主要终点事件(缺血性卒中、全身性栓塞)、次要终点事件(非致命性心肌梗死、全因死亡联合终点)、安全性终点事件(致命性出血、严重出血和轻度出血)的情况。结果:随访期间,中等强度抗凝组中有3例患者发生栓塞,发生率为5.36%;低等强度抗凝组中有6例发生栓塞,发生率为11.54%,均为脑卒中,2组间差异有统计学意义(P<0.05)。低等强度抗凝组中2例、中等强度抗凝组中3例患者出现眼结膜、鼻出血等不良反应,但均无严重出血,2组间出血发生率差异无统计学意义(P>0.05)。结论:超高龄房颤患者应用华法林,INR维持在1.81~2.50是安全、有效的。
Objective: To observe the occurrence of cardiovascular adverse events after warfarin anticoagulation with different intensities in patients with ultra-aged atrial fibrillation and to explore the reasonable range of international normalized ratio (INR) for such patients, so as to provide the basis for clinical practice. Methods: One hundred and eighty patients with AF (age ≥80 years) were divided into moderate-intensity anticoagulation group (56 cases) and low-intensity anticoagulation group (52 cases) by INR value. The INR of low-intensity anticoagulation group Maintained at 1.40 ~ 1.80; moderate-intensity anticoagulant group maintained at INR 1.81 to 2.50. Follow-up (1.8 ± 1.2 years) observed major endpoints (ischemic stroke, systemic embolism), secondary endpoints (nonfatal myocardial infarction, all-cause death combined endpoints), endpoints of safety (fatal bleeding , Severe bleeding, and mild bleeding). Results: During the follow-up period, embolization occurred in 3 patients in the moderate-intensity anticoagulation group and in 5.36% in the low-intensity anticoagulation group, with a rate of 11.54% The difference was statistically significant (P <0.05). There were no adverse reactions such as conjunctival and epistaxis in 3 of the low-intensity anticoagulation group and 3 of the moderate-intensity anticoagulation group, but there was no severe hemorrhage. There was no significant difference in the incidence of hemorrhage between the two groups (P> 0.05 ). Conclusion: Warfarin in patients with ultra-aged AF is safe and effective with INR between 1.81 and 2.50.