低强度华法林抗凝治疗高出血风险房颤患者的有效性及安全性临床研究

Low-intensity warfarin therapy for anticoagulation in atrial fibrillation patients with high risk of hemorrhage: a clinical trial on efficiency and safety

摘要:

目的 应用2010年欧洲心脏病学协会（ESC）房颤新指南提出的新的评分系统卒中危险评分（CHA2DS2-VASc）和首次推出的出血风险评分法（HAS-BLED），观察CHA2DS2-VASc积分≥1分且HAS-BLED出血风险积分≥3分时，低强度华法林抗凝治疗高出血风险房颤患者的抗栓疗效和安全性。方法 2011年1月至2012年1月我院非瓣膜性房颤患者99例，其CHA2DS2-VASc卒中危险评分≥1分且HAS-BLED出血风险积分≥3分。全部病例分成两组，标准强度华法林治疗组[2.0＜国际标准化比值（INR）≤3.0]和低强度华法林治疗组（1.6≤INR≤2.0）。观察两组患者的血栓栓塞率及出血发生率。结果 卡方检验结果显示，两组患者的血栓栓塞率差异无统计学意义（P＞0.05）；标准强度华法林治疗组的出血发生率高于低强度华法林治疗组患者，差异有统计学意义（P＜0.05）。结论 CHA2DS2-VASc卒中危险评分≥1分且HAS-BLED出血风险积分≥3分的高出血风险的房颤患者可以采用低强度华法林抗凝，能有效减少血栓栓塞事件的发生，同时不增加严重出血事件，使用安全可靠。

Abstract:

Objective To determine the safety and availability of anticoagulation of low-intensity warfarin therapy in atrial fibrillation (AF) patients with high risk of stroke and bleeding applying stroke risk score (CHA2DS2-VASc) and bleeding risk score (HAS-BLED) (CHA2DS2-VASc≥1 and HAS-BLED≥3) proposed by 2010 European Society of Cardiology Guideline. Methods A total of 99 AF patients who had the stroke risk scoring CHA2DS2-VASc≥1 and HAS-BLED score≥3 admitted in our hospital from January 2011 to January 2012 were selected randomly, and then divided into 2 groups. One group was treated by a standard intensity warfarin therapy of 2.0＜International Normalized Ratio (INR)≤3.0, and the other group was given a low-intensity warfarin therapy (1.6≤INR≤2.0). The incidence of stroke and bleeding events of the two groups were compared. Results Chi-square test indicated that there was no statistical difference in the incidence of stroke and bleeding between these 2 groups (P＞0.05). The incidence of bleeding was significantly higher in standard-intensity Warfarin group than in low-intensity Warfarin group (P＜0.05). Conclusion AF patients with high bleeding risk (CHA2DS2-VASc≥1 and HAS-BLED score≥3) should be treated by low-intensity warfarin anticoagulation. The therapy is safe and reliable, with advantages of suppressing thrombosis and embolism events and not increasing serious hemorrhage.