| Objective:To investigate the efficacy and safety of long-term anticoagulation therapy with low intensity warfarin in elderly patients with atrial fibrillation,and to provide dose of basis for clinical anticoagulation therapy.Method:127 cases of patients with atrial fibrillation after electrocardiogram examination in Chinese PLA 406 Hospital from 1.2015~1.2016 were chosen.And the patients all had the stroke risk scoring CHA2DS2VASc?1 and HAS-BLED?3(according to the scoring system in the 2010 Europe Society of Cardiology Guideline).They were randomly divided into two groups:group A of 64 patients was treated by the standard intensity warfarin therapy(2.0<INR?3.0),and the other group was treated by a low intensity warfarin therapy(1.6?INR?2.0).All the patient's general information(such as age,gender,weight)was recorded,and they should do the routine blood test,urinary occult blood test,liver and renal function test,and the echocardiogram test without left atrial thrombus and other disease.At the same time,we need to record the patient's course and treatment information.Group A was treated by the standard intensity warfarin therapy,the initial dosage was 2.5mg and the dose was changed according to the INR result,making sure that the INR maintained between 2.1~3.0.And the other group was treated by a low intensity warfarin therapy,the initial dosage was 1.5mg and the dose was changed according to the INR result,making sure that the INR maintained between 1.6~2.0.Observing the incidence of stroke and bleeding event of the two groups for 12 months.Using SPSS23.0 statistical software for statistical analysis.Result:There were 127 chosen patients and the duration of follow-up is 12 months.During that time,in group A:there were 2 cases lost to follow-up and 1 case due to poor adherence withdrew from the study,in group B,there was 1 case due to poor adherence withdrew from the study.Group A has 61 cases,the maintain dose of Warfarin was 3.06 ± 0.19mg/d,time for INR fist reaching to the standard was 12.79 ± 3.88 days,and the stable value was 2.57 ± 0.14.Among them,there were 2 case of the cerebral embolism,1 case of the left leg incompleteness artery embolism with 4.92% of stroke incidence.And in this group,3 cases of digestive canal bleeding,2 cases of skin bleeding,6 cases of gingival bleeding,2 cases of urinary system bleeding,1 case of the intracerebral hemorrhage with 22.95% of the bleeding incidence.There were 62 cases in group B,the maintain dose of Warfarin was 2.45 ± 0.17mg/d,time for INR fist reaching to the standard was 10.62 ± 3.63 days,and the stable value was 1.81 ± 0.09.And in this group,there was 1 case of the transient ischemic attack,1 case of the superior mesenteric artery embolism and 1 case of the right leg artery embolism with 4.84% of stroke incidence.And in this group,1 case of digestive canal bleeding,2 cases of skin bleeding,1 case of gingival bleeding,1 cases of urinary system bleeding with 8.06% of the bleeding incidence.Analyzing the data of the two groups,the incidence of stroke was not statistically significant(P>0.05).Bleeding incidence rate of the group A was significantly higher than that of the group B(P<0.05).Conclusion: 1.The incidence of stroke was not statistically significant between two groups,proposing that low intensity anticoagulation warfarin can also effect equally effective.2.The incidence of bleeding in the low intensity anticoagulation warfarin group was lower than the standard group,proposing that low intensity anticoagulation warfarin can effectively reduce the incidence of bleeding events. |
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