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Title:: Effect of warfarin on prethrombotic state and heart function of high risk patients with permanent atrial fibrillation

作者:: 唐方明; 郑云龙; 包浔娜; 赵红娟; 陈冠鹏; 广东省农垦中心医院心内科，广东湛江 524002

Author(s):: TANG Fangming; ZHENG Yunlong; BAO Xunna; ZHAO Hongjuan; CHEN Guanpeng; Department of Internal Medicine, Central Hospital of Agriculture Reclamation, Zhanjiang 524002, Guangdong, China

关键词:: 心房颤动; 华法林; 血栓前状态; 心功能

Keywords:: atrial fibrillation; warfarrin; prethrombotic state; heart function

分类号:: R972.2;R541.75

DOI:: -

文献标识码:: A

摘要:: 目的探讨调整剂量华法林［国际标准化比值(INR) 2~3］对高危持续性心房颤动(AF)患者血栓前状态和心功能的影响。方法 99例高危持续性AF患者随机给予阿司匹林(100 mg/d，阿司匹林组)或调整剂量华法林(华法林组)治疗1年。于治疗前、治疗后6个月和12个月分别检测血栓前状态（PTS）各分子标志物，采用免疫比浊法测定D二聚体水平，采用ELISA双抗体夹心法测定血小板α颗粒膜蛋白(GMP)140、血浆血栓调节蛋白（TM）和血浆凝血酶抗凝血酶III复合物（TAT）水平；超声测定心排出量(CO)和左室射血分数(LVEF)，进行前后比较分析。随访中观察有无血栓栓塞和出血并发症发生。结果 ①与阿司匹林组比较，华法林组治疗6个月、12个月后D二聚体、GMP140、TAT、TM水平均显著降低，CO、LVEF均显著增加（P<005）；②随访期间两组均无血栓栓塞事件发生，华法林组有1例出现上消化道大出血，经治疗痊愈。结论调整剂量华法林能不同程度地改善高危AF患者的血栓前状态和心功能，疗效优于阿司匹林，治疗是安全的。

Abstract:: AIM To investigate the changes of prethrombotic state and heart function after doseadjusted warfarrin anticoagulation treatment in high risk patients with permanent atrial fibrillation. METHODS Ninetynine patients were treated randomly with aspirin or doseadjusted warfarrin (INR23) for one year. The level of DDimer was measured by immune turbidimetry and the levels of GMP140, TAT and TM were measured by enzyme linked immunoadsorbent assay (ELISA), and CO and LVEF were detected by echocardiogram, before treatment and 6 and 12 months after anticoagulation treatment. The state of thromboem bolism or hemorrhage was observed. RESULTS ①The levels of DDimer, GMP140, TAT and TM were reduced and CO and EF increased in patients treated with INR23 compared with those in patients treated with aspirin（P<0.05）. ②No thromboembolism was observed in all the patients, but one case of hemorrhage was found in patients treated with warfarrin. CONCLUSION Doseadjusted warfarrin improves prethrombotic state and heart function in high risk patients with permanent atrial fibrillation and INR23 is safe and more effective than aspirin.

参考文献/References

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华法林对高危持续性心房颤动患者血栓前状态和心功能的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

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