【摘要】 目的探讨不同抗凝强度的华法林对≥80岁老年非瓣膜性心房颤动患者肾功能的影响。方法 242例老年持续性或永久性房颤患者按华法林用药强度随机分成3组:低强度抗凝组[国际标准化比率(INR)1.5~2.0]、标准强度抗凝组(INR 2.1~3.0)以及阿司匹林组(100 mg/d)。随访24月后,观察3组肾功能的变化、出血事件、缺血性脑卒中、心肌梗死以及非中枢神经系统栓塞的发生率。结果随访24月后,华法林组的血清肌酐清除率为64.4±14.9,较基线水平(58.7±15.0)轻度升高,而阿司匹林组则明显下降(59.2±13.9比50.0±15.1,P=0.041)。阿司匹林组缺血性脑卒中的发生率约16.1%(13/81),明显高于低强度华法林组(5/81,6.2%,P=0.028)和标准强度组(4/80,5%,P=0.015)。低强度抗凝组出血发生率最低(7.4%)。结论低强度华法林对预防老年房颤脑卒中是有效及安全的,且对肾功能有一定的改善作用。更多还原

【Abstract】 Objective To investigate the influence of different intensity warfarin on renal function and ischemic stroke in octogenarian patients with nonvalvular atrial fibrillation( NVAF). Methods 242 persistent or permanent NVAF patients over 80 years old were randomly divided into low intensity warfarin group( INR 1. 5-2. 0),standard intensity warfarin group( INR 2. 1-3. 0) and aspirin( 100 mg / d) group. Patients were followed up for 24 months. The effects on renal function and the rate of ischemic stroke,non-central nervous systemic embolism and myocardial infarction were observed. Results The estimated serum creatinine clearance rate( Ccr) was slightly increased in warfarin group after 24-month follow-up. Meanwhile,Ccr significantly decreased in aspirin group( P = 0. 041). The incidence of ischemic stroke was ob-viously higher in aspirin group( 13 /81,16. 1%) than that in the low intensity warfarin group( 5 /81,6. 2%,P = 0. 028) and standard intensity warfarin group( 4 /80,5%,P = 0. 015). Conclusions Low intensity warfarin is effective and safe in preventing ischemic stroke and preserving renal function in Chinese elderly NVAF patients.更多还原