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口服华法林可用于预防和治疗动静脉血栓形成和栓塞,但由于华法林治疗指数窄,需要认真监测以达治疗目标。本研究旨在观察和评估两种不同剂量华法林治疗方案在中国患者中的疗效。查阅2008年9月至2009年12月心脏瓣膜手术患者的病历,筛选手术后第一天就开始使用华法林治疗的368名患者,采用交叉设计方案,对患者进行随机分组,以国际标准化比值(INR)反映抗栓治疗结果详情。两组患者住院期间分别接受两种不同规格(中国2.5mg,美国3mg)华法林抗凝治疗,对其抗凝结果进行统计学分析,以评价预测INR治疗范围的因素。患者的平均年龄为(48.23±12.96)岁。2.5mg组患者INR在治疗范围的比例低于3mg组(35.17%,47.72%),两者具有显著性差异(P=0.032<0.05)。研究显示INR目标范围1.8–2.2和2.0–2.5之间有显著关联,统计学分析显示各自P值为0.031和0.025。两组患者在治疗期间有显著性差异。大部分患者都需要终生治疗(P=0.035)。统计学研究表明,规格3.0mg华法林较2.5mg华法林更优。在不同治疗期间应尽可能简化治疗方案。
Oral warfarin can be used to prevent and treat arteriovenous thrombosis and embolism, but due to the narrow warfarin treatment index, careful monitoring is needed to achieve therapeutic goals. This study aimed to observe and evaluate the efficacy of two different doses of warfarin in Chinese patients. The medical records of patients undergoing valvular heart surgery from September 2008 to December 2009 were reviewed and 368 patients on warfarin therapy were screened on the first day after surgery. Patients were randomized using a crossover design and the international standardized ratio (INR) reflects the details of the antithrombotic outcome. Two groups of patients received warfarin anticoagulation therapy of two different specifications (2.5mg in China and 3mg in the United States respectively) during hospitalization. The anticoagulant results were statistically analyzed to evaluate the factors that predict the therapeutic range of INR. The average age of patients was (48.23 ± 12.96) years. INR in the 2.5 mg group was lower than that in the 3 mg group (35.17%, 47.72%), with significant difference (P = 0.032 <0.05). Studies have shown a significant association between the INR target range of 1.8-2.2 and 2.0-2.5, with statistical analysis showing respective P values of 0.031 and 0.025. There was a significant difference between the two groups during treatment. Most patients require life-long treatment (P = 0.035). Statistical studies have shown that 3.0mg warfarin is better than 2.5mg warfarin. In different treatment should simplify the treatment plan as much as possible.