ABSTRACT
Objective To compare the efficacies and safety of warfarin with different anticoagulation intensities in treatment of nonvalvular atrial fibrillation. Methods Cochrane Library, EMbase. PubMed, Chinese Journal Full-text Database (CNKI) . Wanfang Data and VIP Database (VIP) were searched by computer for randomized controlled trials of warfarin with different anticoagulation intensities in treatment of nonvalvular atrial fibrillation. The analysis was performed using the Review Manager 5. 3. Results Finally a total of 14 literatures involving 3 295 participants were included. The results of meta-analysis showed the following: low anticoagulation intensity group (INR: 1. 5 2. 0, n — l 403) had a total bleeding rate significantly lower than the standard anticoagulation intensity group (INR- 2. 0-3. 0. n=1 892) (RR=0. 47, 95.%CI- 0. 37-0. 59. P< 0. 000 01) ; there were no significam differences in the incidence of thromboembolism (RR=1. 35, 95%CI: 1. 00-1. 84, P = 0. 05), ischemic strokc (RR=1. 44. 95%CI: 1. 01 2. 05, P=0. 05) or mortality (RR=1. 06. 95% Cl: 0. 85 1. 31, P = 0. 60) between the two groups. Conclusion Warfarin therapy in international normalized ratio of 1. 5-2. 0 can reduce the risk of fatal and severe bleeding in patients with nonvalvular atrial fibrillation, and may not increase the incidence of thromboembolism.
ABSTRACT
Objective To investigate the necessity of low-intensity anticoagulation standard in patients after heart valve replacement and the rationality of INR in our hospital.Methods 681 eligible candidates were anticoagulated under the current guidelines for postoperative anticoagulation therapy in our hospital(AVR 1.5-2.0,MVR 2.0-2.5,DVR 2.0-2.5,TVR 2.5-3.0).We monitored the patient 's PT regularly and analyzed the occurrence of anticoagulation-related complications,such as bleeding,thrombosis and embolism.Results 602 cases completed the follow-up.During the period of follow-up,66 patients had bleeding tendencies,the incidence of bleeding complications was 10.96％ (66/602).1 1 patients had embolism complications,the incidence of thrombotic complications was 1.83 ％ (11/602).The average of INR was 2.24± 0.68,the mean oral Warfarin dose was(3.12± 1.14) mg/d.Conclusion Our study suggest that the effect of low-intensity anticoagulation after heart valve replacement is reliable.Further more,the current anticoagulation standards of our hospital meet the requirements of postoperative clinical anticoagulant after heart valve replacement in our region.