Long-term follow-up study of warfarin anticoagulant therapy effect of different intensity on patients with nonvalvular atrial fibrillation / 心血管康复医学杂志

ABSTRACT

Objective: To analyze long-term therapeutic effect and safety of warfarin anticoagulant therapy of different intensity on aged patients with nonvalvular atrial fibrillation (NVAF). Methods: According to age, a total of 197 NVAF patients followed up for five years were divided into advanced aged group [n=65，≥80(85±2.09)years], aged group [n=75, 65-79(76.5±2.27) years] and middle-aged group [n=57, ＜65(57.4±2.18)]. All enrolled patients received long-term warfarin anticoagulant therapy, advanced aged group and aged group received low intensity anticoagulation, international normalized ratio (INR) was 1.6~2.5, while middle-aged group received standard intensity anticoagulation and the INR was 2.0~3.0. Thrombus events and incidence rates of hemorrhage etc. over five years were compared among three groups, and the safe dose range of warfarin was explored. Results: During five-year follow-up, no acute cerebral infarction occurred in three groups. The bleeding and other adverse reaction among three groups were no significant difference（P＞0.05). Compared with middle-aged group, there were significant reductions in warfarin dose [(3.29±0.49) mg/d vs. (2.95±0.38) mg/d, (2.85±0.49) mg/d],INR [(2.54±0.43) vs. (2.20±0.29), (2.16±0.32)] and CHA2DS2-VASc [(3.02±0.89) score vs.( 2.64±0.77) score vs.( 2.33±0.48) score]in aged group and advanced aged group, P＜0.01 all; but there were no significant difference between aged group and advanced aged group (P>0.05). There were no significant difference in incidence rates of mild hemorrhage (21.1% vs. 14.7% vs. 24.6%) and severe hemorrhage (1.8% vs. 1.3% vs. 1.5%) among middle-aged group, aged group and advanced aged group, P>0.05 all. Conclusion: When INR is closely monitored, INR controlled within 1.6~2.5, warfarin anticoagulation is safe and effective in aged patients with nonvalvular atrial fibrillation.