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1、华法林在非瓣膜性心房颤动抗凝治疗预防缺血性脑中风［摘要］目的探讨华法林在非瓣膜性心房颤动患者抗凝治疗中预防缺血性脑中风效果及出血风险。方法整群选取2010年11月一2013年12月医院收治的172例非瓣膜性房颤患者为研究对象，按出血风险评分分为低危组及高危组，低危组口服华法林中等强度抗凝，国际标准化比率(TNR)控制在2.0-3.0,高危组患者口服华法林低等强度抗凝，INR控制在1.5~2.5；观察记录两组患者治疗随访期间缺血性脑卒中风险与出血栓塞等不良反应情况。结果低危组缺血性脑卒中、短暂性脑缺血
2、发作、外周动脉栓塞发生率(6.49%.2.60%>1.30%)与高危组(7.37%、3.16%、3.16%)比较，差异无统计学意义(P>0.05)；低危组INR值(2.62±0.33),高危组1帰值(1.86±0.31),两组比较差异有统计学意义(t=15.532,P0.05)；低危组患者栓塞、出血、腹部不适发生率为9.09%.2.60%.1.30%,与高危组(9.47%.4.21%.2.11%)比较，差异无统计学意义(P>0.05)；采用INR诊断患者出血风险，ROC曲线下面积为0.887(95%
3、CI：0.827—0.946),TNR的cut-off值2.85,该值下判断出血敏感性为81.1%,特异性为67.2%。结论华法林在非瓣膜性心房颤动患者抗凝治疗屮，依据出血风险调整其抗凝强度可预防缺血性脑卒中及降低患者出血风险。［关键词］华法林；非瓣膜性心房颤动；缺血性脑卒中［中图分类号］R5［文献标识码］A［文章编号］1674-0742(2015)10(a)-0119-04WarfarininAnticoagulationTherapyofNon-valvularAtrialFibrillatio
4、ntoPreventIschemicStrokeLETJian-lin,CATLi-yunDepartmentofInternalMedicine-Cardiovascular,TheThirdHospitalofXiamen,Xiamen,FujianProvince,361100China[Abstract]ObjectiveThisaimistoexploretheeffectofwarfarininanticoagulationtherapyofpatientswithnon-valvula
5、ratrialfibrillation,anditspreventionofischemicstrokeandbleedingriskinpatients・MethodsAtotalof172patientswithnon一valvularatrialfibrillationfromNovember2010toDecember2013inourhospitalwereselected.Theyweredividedinto1owriskgroupandhigh-riskgroupsaccording
6、tothebleedingriskscore.Patientsinlow~riskgroupweregivenmoderate~intensitywarfarinanticoagulation,internationalnormalizedratio(INR)wascontrolledin2.0〜3.0,patientsinhigh-riskgroupweregivenlowintensitywarfarin且nticoagulation,INRwascontrolledin1.5〜2.5.Adve
7、rsereactionsandischemicstrokeriskintwogroupsofpatientswererecordedduringfollow-up.ResultsTheischemicstroke,transientischemicattack,peripheralarterialembolismincidenceinlow-riskgroupwas6.49%,2.60%,1.30%,whileitwas7.37%,3.16%,3.16%inthehigh-riskgroup,the
8、differencewasnotstatisticallysignificanee(P>0.05).INRvalueoflowriskgroupwas(2.62±0.33),whichwas(1.86±0.31)inhigh-riskgroup,therewasstatisticaldifferencebetweenthegroups(t二15.532，P0.05)•Embolism,bleeding,abdominaldiscomfortincidenceratei
