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目的观察老年心房纤颤(房颤)患者使用口服抗凝药进行抗栓治疗的临床效果。方法选择2010—2011年年龄大于75岁持续性房颤患者232例。依据CHA2DS2系统评分大于2分栓塞风险较高,建议口服抗凝药抗栓治疗,HAS-BLED评分系统大于3分相对出血风险较高,需综合评估风险与收益选择治疗方案。根据不同的抗栓治疗方案将所有病例(232例)随机分为华法林组(95例)、阿司匹林组(103例)与氯吡格雷组(39例)。记录所有患者基本临床资料(性别、年龄、高血压病史、糖尿病史、卒中史、冠心病史等),观察各组间基本资料分布情况和口服药物6个月内定期随访患者不良事件的发生情况。结果在华法林组有高血压59例(62.1%),阿司匹林组75例(72.8%),高于氯吡格雷组7例(20.6%),经比较,差异有统计学意义(P<0.01);其他基本临床资料3组间差异无统计学意义。华法林组CHAD2S2-VASc评分明显高于阿司匹林组和氯吡格雷组,差异有统计学意义(4.2±1.1 vs 3.9±0.9,3.6±0.7,P<0.05);栓塞发生率氯吡格雷组4例(11.8)、阿司匹林组9例(8.7),与华法林组1例(1.1%)比较,差异有统计学意义(P<0.05)。3组间HAS-BLE评分、轻微出血、大出血比较,差异无统计学意义。3组均无死亡病例。结论对于栓塞及出血风险均相对较高的老年房颤患者,使用口服抗凝药将国际标准化比值(INR)控制在2.0～3.0之间可明显降低栓塞发生率,并未明显增加出血风险。
Objective To observe the clinical effect of antithrombotic therapy in elderly patients with atrial fibrillation (AF) using oral anticoagulation. Methods A total of 232 consecutive patients with atrial fibrillation over the age of 75 years from 2010 to 2011 were selected. According to CHA2DS2 system score greater than 2 points higher risk of embolization, it is recommended oral anticoagulant antithrombotic therapy, HAS-BLED scoring system is higher than the relative risk of bleeding is relatively high, the risk and benefit of a comprehensive assessment of treatment options. All cases (232 cases) were randomized to warfarin (95), aspirin (103) and clopidogrel (39) according to different antithrombotic regimens. The basic clinical data (gender, age, history of hypertension, history of diabetes, history of stroke, history of coronary heart disease, etc.) of all patients were recorded. The distribution of basic information among groups and the occurrence of adverse events during regular follow-up within 6 months . Results There were 59 cases (62.1%) in warfarin group, 75 cases (72.8%) in aspirin group and 7 cases (20.6%) in clopidogrel group, the difference was statistically significant (P <0.01 ); Other basic clinical data 3 no significant difference between groups. The CHAD2S2-VASc score in warfarin group was significantly higher than that in aspirin group and clopidogrel group (4.2 ± 1.1 vs 3.9 ± 0.9, 3.6 ± 0.7, P <0.05). The incidence of embolism was lower in clopidogrel group 4 There were 9 cases (8.7%) in the aspirin group and 1 case (1.1%) in the warfarin group. The difference was statistically significant (P <0.05). HAS-BLE score, mild bleeding and bleeding were not statistically significant among the 3 groups. No deaths occurred in all three groups. Conclusions For elderly patients with atrial fibrillation who have a relatively high risk of embolism and bleeding, the use of oral anticoagulants to control the INR between 2.0 and 3.0 significantly reduces the incidence of embolization without significantly increasing the risk of bleeding.