低剂量华法林对心房颤动患者脑卒中和凝血指标的影响

目的 探讨心房颤动患者低剂量长期使用华法林对患者脑卒中和凝血指标的影响。方法 选择2016年1月—2018年12月喀什地区第一人民医院收治的心房颤动患者213例作为研究对象,按照随机数字表法将患者分为3组,每组各71例。对照组患者使用阿司匹林肠溶片,200 mg/d。华法林高剂量组患者在使用华法林钠片前测定抗凝强度国际化标准比率（INR）作为基础值,初始剂量为2.5 mg/d,每隔3~5 d复查IRN,根据IRN调整使用剂量,每次增加0.625 mg,直至复查INR达标,达标时IRN值为2.1~3.0。华法林低剂量组患者使用华法林初始量为1.25 mg/d,每隔3~5 d复查IRN,达标时IRN值为1.5~2.0。根据IRN调整使用剂量,如果INR<1.5,每次增加0.625 mg,直至复查INR达标;如果INR>2.1,将华法林剂量减少0.625 mg。INR不稳定时,连续达标2次后以该剂量作为维持剂量,每月复查1次,直至INR达标。3组均治疗随访18个月。观察并比较两组患者的脑卒中发生情况、凝血指标、华法林用量、达INR标准时间和不良反应发生情况。结果 随访后,华法林高剂量组脑卒中发生率为2.82%,华法林低剂量组为4.23%,均明显低于对照组的14.08%,组间差异具有统计学意义（P<0.05）。治疗后,3组活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）均明显延长（P<0.05）,华法林高剂量和低剂量APTT、PT显著优于对照组,组间差异具有统计学意义（P<0.05）。华法林低剂量组华法林使用量和INR达标准值时间均明显低于华法林高剂量组（P<0.05）。治疗期间,华法林高剂量组出血、腹部不适等不良反应发生率为9.86%,华法林低剂量组为5.63%,均明显低于对照组的29.58%（P<0.05）。结论 心房颤动患者长期使用低剂量华法林能够有效的达到预防脑卒中的效果,其疗效与标准抗凝强度相当,且明显优于阿司匹林,具有较高的临床应用价值,可推广使用。     

参松养心胶囊致INR值降低2例及文献回顾

目的 探讨参松养心胶囊对华法林抗凝作用的影响、作用机制和处理方法。方法 采用病例回顾方式,1例62岁非瓣膜病房颤女性服用华法林抗凝治疗后INR>2,加用参松养心胶囊4 d后INR降至1.68,停用参松养心胶囊4 d后INR值升至2以上;另1例57岁非瓣膜病房颤男性服用稳定剂量（4.0 mg·d^-1）的华法林抗凝治疗,服用参松养心胶囊后INR值降至1.56,后增加华法林剂量至4.5 mg·d^-1,INR值升至2以上。结果 患者在稳定的华法林治疗剂量基础上加用参松养心胶囊（含有人参）后,减弱了华法林的抗凝效果。可能的机制是人参轻度诱导了CYP2C9,但是尚不能排除人参的血小板抑制作用等其他可能的机制。结论 服用华法林期间应尽可能避免服用人参等草药,如果坚持加用人参及含人参药物后,建议持续监测INR值,并根据INR值调整剂量。     

药物基因组学模型对机械瓣膜置换术后华法林低强度抗凝治疗剂量预测效果的评价

目的 评价华法林药物基因组学模型对机械瓣膜置换术后华法林低强度抗凝治疗剂量预测效果。方法 按照设定的标准选取皖南医学院弋矶山医院2012年1月-2013年10月行心脏机械瓣膜置换术后接受华法林低强度抗凝治疗(目标国际标准化比值INR为1.6~2.5)患者107例,采用聚合酶链反应-限制性片段长度多态性方法(PCR-RFLP)和测序技术对CYP2C9和VKORC1基因进行检测。依据INR监测结果调整华法林至稳定剂量,并根据华法林实际稳定剂量将患者分为低剂量组(≤1.5 mg/d)、中剂量组(1.5~4.5 mg/d)和高剂量组(≥4.5 mg/d)。利用国际华法林药物基因组联合会(IWPC)模型计算华法林预测剂量,比较华法林预测剂量与实际稳定剂量的平均绝对误差(MAE),计算预测剂量位于理想剂量(实际稳定剂量20%界限)、高估和低估剂量患者比例,并以华法林预测剂量和实际稳定剂量拟合相关回归曲线R²评价该模型预测剂量的准确性。结果 华法林预测剂量与实际稳定剂量MAE为(0.89±0.62) mg/d,相关回归系数R²为0.325,预测剂量在理想剂量范围内的比例为42.06%,其中高剂量组位于理想剂量范围内比例为50.00%,高于中剂量组(43.75%)和低剂量组(11.11%)。结论 IWPC模型对中国汉族人群华法林剂量预测的效果有限,适合于中国汉族人华法林低强度抗凝治疗药物的基因组学模型仍需进一步大规模临床研究和验证。     

IWPC模型对下肢深静脉血栓形成患者 华法林初始低强度抗凝疗效的影响

目的：评价国际华法林药物基因组学联合会（IWPC）模型对下肢深静脉血栓形成患者（DVT）华法林初始抗凝疗效的影响。方法：100例DVT患者随机分为两组：研究组68例和对照组32例,均给予华法林抗凝治疗。研究组患者采用荧光染色原位杂交分析技术进行CYP2C9和VKORC1基因检测,利用IWPC模型计算华法林初始剂量,并根据国际标准化比值（INR）监测结果调整华法林至合适剂量;对照组直接根据INR监测结果调整华法林至合适剂量。比较两组患者在INR首次达标时间、INR达标维持时间、华法林抗凝治疗3、5、7天INR、INR达标率和INR总达标率、7天华法林累积剂量及治疗范围时间（TTR）的差异。结果：研究组患者CYP2C9 1075A＞C基因以AA型为主（91.18%）,C等位基因突变率5.15%,VKORC1 1639AA型79.41%,G等位基因携带率11.03%。研究组患者INR首次达标时间较对照组明显缩短（P＜0.001）,INR达标维持时间明显增加（P=0.02）,华法林抗凝治疗3天INR及INR达标率明显高于对照组（P=0.01）,且TTR为47.27%,较对照组29.01%明显增加（P＜0.001）。结论：IWPC模型有助于提高下肢深静脉血栓形成患者华法林初始抗凝疗效,但其在华法林长期抗凝中的应用价值有待于临床进一步验证。     

肇庆地区人群华法林相关基因CYP2C9*3和VKORC1的多态性分布研究及指导价值

目的 探讨广东省肇庆地区人群华法林相关基因细胞色素P450复合物亚基2C9（CYP2C9）和维生素K环氧还原酶复合物亚基1（VKORC1）多态性分布,并比较性别和中国西双版纳傣族、北京汉族、南方汉族间差异性的分布,为临床医生精准使用华法林进行抗凝治疗提供理论基础。方法 选取2019年5月-2022年1月于肇庆市第一人民医院进行华法林相关基因检测的患者122例,所有患者均采用数字荧光分子杂交技术对CY92C9^*3和VKORC1进行基因多态性检测,比较患者性别间和中国西双版纳傣族、北京地区汉族、南方地区汉族间的基因多态性分布情况,并对比基于药物基因组学指导下的华法林使用剂量与常规剂量使用华法林治疗后2~3 d后国际标准化比值（INR）达标率。结果 122例检测样本中,CY92C9^*3基因位点AA、AC、CC基因型所占的比例分别为95.90%、4.10%、0,C等位基因和T等位基因频率分别为97.95%和2.05%;VKORC1基因位点GG、GA、AA基因型分别为0.82%、19.67%、79.51%,A等位基因和C等位基因频率分别为10.66%和89.34%。不同性别间CY92C9^*3与VKORC1的基因型分布和等位基因分布差异均无统计学意义（P>0.05）。通过已有的数据库进行对比,肇庆地区的CY92C9^*3基因型、等位基因与1000 Genomes Project （1000 GP）西双版纳傣族、北京汉族与南方汉族对比无统计学差异（P>0.05）;但与1000 GP北京汉族对比,VKORC1的基因型和等位基因频率有统计学差异（P<0.05）;与1000GP西双版纳傣族对比,VKORC1的等位基因频率有统计学差异（P<0.05）;华法林在基因组学指导下的剂量与常规剂量治疗后INR达标率差异有统计学意义（P<0.01）。结论 肇庆地区人群存在CY92C9^*3和VKORC1基因多态性,其中VKORC1基因可能存在地域的差异,进行华法林相关基因检测可以为临床制定个体化华法林抗凝方案提供重要的参考价值。     

达比加群酯预防房颤患者卒中的临床研究

目的 观察达比加群酯预防房颤患者卒中的疗效及安全性。方法 纳入房颤患者80例均符合抗凝治疗指征。按照奇偶数法随机分为观察组（n=40）和对照组（n=40）。观察组给予达比加群酯110 mg,2次/d;对照组给予华法林2.5 mg/d,并定期测定国际标准化比值（INR）,根据INR调整剂量。两组疗程均为6个月。记录两组患者卒中、全身性栓塞和大出血发生情况。两组患者出院时检查凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）和D-二聚体等凝血指标。结果 观察组患者卒中/全身性栓塞的发生率为17.5%,对照组为37.5%,两组患者卒中/全身性栓塞发生率有统计学差异（P<0.05）;观察组患者大出血发生率显著低于对照组,差异有统计学意义（P<0.05）。两组患者凝血功能指标差异均无统计学意义。治疗后,两组血脂水平均较治疗前显著改善,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组血脂水平改善更为明显,组间差异有统计学意义（P<0.05）。结论 与华法林比较,对有房颤患者行抗凝治疗达比加群酯具备同等疗效,且安全性更高。     

心脏瓣膜置换术后影响华法林抗凝达标的相关因素分析

摘 要 目的：探讨心脏瓣膜置换术后使用华法林抗凝患者的国际标准化比值（INR）达标相关影响因素。 方法：应用回顾性分析方法,随机抽取某三甲教学医院2018年1~12月瓣膜置换术后使用华法林患者病例资料100份,根据出院时INR值达标情况分为达标组与未达标组,采用单因素分析及二元Logistic回归模型,对INR达标情况及其影响因素进行分析。 结果：INR值达标组39例,未达标组61例。Logistic回归分析结果显示,术后联用阿司匹林患者的INR值达标可能性低于未联用患者[OR=0.220,95%CI（0.063,0.772）],术后联用贝那普利患者较未联用患者的INR值更可能达标[OR=2.541,95%CI（1.026,6.295）],监测INR值次数＞5较监测次数≤5的患者INR值更可能达标[OR=7.701,95%CI（2.037,29.112）]。 结论：联用阿司匹林、联用贝那普利、监测INR值次数（＞5）是影响心脏瓣膜置换术后华法林抗凝INR值达标的主要因素,应结合相关影响因素,为临床药师指导个体化使用华法林提供初步的参考依据。     

CYP2C9 VKORC1基因多态性指导对非瓣膜性心房颤动患者华法林剂量的影响

目的 探讨CYP2C9、VKORC1基因多态性对非瓣膜性心房颤动（NVAF）患者华法林应用剂量的影响。方法 选择合肥市第二人民医院2017年11月至2019年10月收治的214例NVAF患者,采用随机数字表法分为基因指导组（69例）与对照组（145例）,基因指导组检测VKORC1、CYP2C9基因多态性,对照组按常规剂量给予华法林,比较两组患者华法林起效剂量、有效剂量、起效时间及第14、21天达稳定剂量患者比例等指标。结果 基因指导组患者在华法林应用初始剂量为（1.67±1.63）mg、稳定剂量为（2.02±0.94）mg,均低于对照组,起效时间为（7.62±2.87）d,短于对照组短,差异有统计学意义（P<0.05）。CYP2C9、VKORC1组华法林应用初始剂量、稳定剂量均低于对照组,起效时间短于对照组,差异有统计学意义（P<0.05）。基因指导组第14、21天达稳定剂量患者比例（76.44%、98.27%）高于对照组,差异有统计学意义（P<0.05）。结论 VKORC1、CYP2C9基因多态性检测结合NVAF患者临床特点可为临床精准合理应用华法林提供参考。     

62例深静脉血栓患者华法林用药分析

摘 要 目的:了解我院深静脉血栓患者华法林用药情况及存在的问题并提出建议,促进临床合理用药。 方法：对2013年10月~2014年3月我院服用华法林治疗深静脉血栓的住院患者病历进行回顾性调查分析,调查内容包括在院期间华法林联合用药、用药期间国际标准化比值（INR）监测、华法林剂量调整等情况,并参照国内外指南进行综合评价和分析。结果：共收集62例患者病历,我院尚存在患者服用华法林期间联用药物种类多、INR监测不规范、华法林剂量调整不及时、住院期及出院前INR达标率低等问题。结论：目前我院华法林用药尚存在不足,需参照指南制定华法林用药规范,指导临床合理使用华法林进行抗凝治疗。     

丹红注射液对大鼠体内华法林抗凝作用的影响

摘 要 目的： 研究丹红注射液对大鼠体内华法林抗凝作用的药效学和药动学影响及其作用机制,为临床合理用药提供参考。方法: Wistar大鼠随机分为空白对照组（Ⅰ）、丹红注射液给药组（Ⅱ）、华法林对照组（Ⅲ）和丹红注射液与华法林联合给药组（Ⅳ）,每组8只。四组大鼠连续14d腹腔注射给予生理盐水或丹红注射液。在第8天,Ⅰ、Ⅱ组给予生理盐水灌胃1次,Ⅲ、Ⅳ组给予等量华法林溶液。分别于给药后的既定时间点采血,测定凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）值,计算国际标准化比值（INR）,采用UPLC-MS/MS法测定S-华法林和R-华法林的血药浓度并计算相关药动学参数。结果: 丹红注射液能升高大鼠的PT和INR值（P<0.01）,与华法林合用能使大鼠PT和INR值显著增加（P<0.01）,APTT值升高（P<0.05）。联合给药组与华法林对照组比较,S-华法林的C_max、AUC_0-t、AUC_0-∞分别增加了90.72%、52.17%、43.13%（P<0.01）,t_1/2增加了14.76%（P<0.05）;R-华法林的C_max、AUC_0-t、AUC_0-∞分别增加了56.89%、79.10%、77.96%（P<0.01）,t_1/2增加了17.17%（P<0.05）。结论:丹红注射液与华法林联合应用时会增加华法林的抗凝作用,出血风险增加,应避免联合使用,或注意密切监测。     

基于人工神经网络模型预测华法林服药者国际标准化比值

目的 探究CYP2C9*2、CYP2C9*3、CYP4F2、VKORC11173C>T基因多态性与华法林维持剂量之间的相关性,建立华法林服用者用药后国际标准化比值(international normalized ratio,INR)的人工神经网络预测模型,提高稳定剂量预测准确性。方法 回顾性研究2019—2021年收集的214例服用华法林达到稳定抗凝患者的临床资料与华法林药物基因数据,分析临床因素与各基因型对患者华法林稳态剂量的影响;建立机器学习预测模型,采用模拟输入患者华法林剂量计算INR靶值的方式来预测稳态剂量,与直接剂量预测方法以及多元回归模型对比准确性。结果 多元回归模型对数据集中患者稳态剂量的预测最佳准确度56.4%,机器学习的预测模型输入稳态剂量预测INR值时的平均绝对误差(mean absolute error, MAE)为0.40,R2为0.81,直接预测剂量时MAE为0.52,R2为0.68,在进行分组训练后误差能够降低20.4%,准确率提高7.3%。结论 通过模拟输入药物剂量预测INR的人工神经网络华法林模型能够更准确地预测患者稳态剂量,有利于实现个体化给药...     

Effect of oral diuretics on chronic warfarin therapy: a retrospective study

Background: Limited clinical documentation is suggestive of a drug interaction between warfarin and diuretics.

Objective: To evaluate the effect on international normalized ratio (INR) when a daily oral diuretic is started or increased in patients on chronic stable warfarin therapy.

Methods: The medical records of all active patients of two hospital-based anticoagulation clinics were retrospectively reviewed to identify patients who were started on or received a dose increase of a daily oral diuretic while on stable warfarin therapy. The primary endpoint was the mean difference between an INR recorded within 30 days prior to the diuretic initiation (pre-INR) and an INR recorded within 30 days after diuretic initiation (post-INR).

Results: A total of 1254 patient charts were screened and a total of 123 patients met the study criteria. The mean difference in pre-INR and post-INR was 0.09 (95% CI -0.03 to 0.21, p = 0.12). Post-INR values were outside of the patient's therapeutic range in 39 patients (32%), but no major bleeding or thromboembolic events were reported.

Conclusion: Based on this retrospective study, diuretics did not result in a significant change in the INR in patients on stable warfarin therapy.     

Amoxicillin/clavulanic acid-warfarin drug interaction: a randomized controlled trial

AIMS

To investigate whether an interaction exists between amoxicillin/clavulanic acid (amoxiclav) and warfarin in patients treated with stable oral anticoagulant therapy.

METHODS

In a double-blind, cross-over, placebo-controlled study, 12 patients on stable warfarin therapy, received a 7 day amoxiclav regimen or placebo.

RESULTS

The mean maximum increase in INR observed was 0.22 ± 0.3 with amoxiclav vs. 0.24 ± 0.6 with placebo (P= 0.94). The day 7–day 1 factor II, R(–) and S(–) warfarin plasma concentrations were similar during the amoxiclav and placebo study periods (P= 0.81, P= 0.45, P= 0.75, respectively).

CONCLUSION

Amoxiclav did not modify anticoagulation in patients treated with stable warfarin therapy and without infection.     

Warfarin time in therapeutic range and its impact on healthcare resource utilization and costs among patients with nonvalvular atrial fibrillation

Background:

Warfarin is efficacious for reducing stroke risk among patients with nonvalvular atrial fibrillation (NVAF). However, the efficacy and safety of warfarin are influenced by its time in therapeutic range (TTR).

Objective:

To assess differences in healthcare resource utilization and costs among NVAF patients with low (<60%) and high (≥60%) warfarin TTRs in an integrated delivery network (IDN) setting.

Methods:

Patients with NVAF were identified from an electronic medical record database. Patients were required to have ≥6 international normalized prothrombin time ratio (INR) tests. NVAF patients were grouped into two cohorts: those with warfarin TTR <60% (low TTR) and those with warfarin TTR ≥60% (high TTR). Healthcare resource utilization and costs were evaluated during a 12 month follow-up period. Multivariable regressions were used to assess the impact of different warfarin TTRs on healthcare costs.

Results:

Among the study population, greater than half (54%, n?=?1595) had a low TTR, and 46% (n?=?1356) had a high TTR. Total all-cause healthcare resource utilization was higher among patients in the low TTR cohort vs. the high TTR cohort (number of encounters: 70.2 vs. 56.1, p?<?0.001). After adjusting for patient characteristics, total all-cause healthcare costs and stroke-related healthcare costs were $2398 (p?<?0.001) and $687 (p?=?0.02) higher, respectively, for patients in the low TTR cohort vs. the high TTR cohort.

Limitations:

In this retrospective study, we were only able to evaluate the association and not the causality between healthcare resource utilization and costs with the different warfarin TTRs.

Conclusion:

Many warfarin-treated NVAF patients have a low warfarin TTR. NVAF patients with low vs. patients with high warfarin TTR used healthcare resources to a greater extent, which was reflected in higher healthcare costs.     

New evidences for old concerns with oral anticoagulation in atrial fibrillation: focus on dabigatran

Introduction: Nonvalvular atrial fibrillation (NVAF) is associated with a fivefold excess risk of stroke. Antithrombotic therapy is crucial to reduce the risk of stroke. During past decades, vitamin K antagonists (warfarin or acenocoumarol) have been widely used for this purpose. However, they have several disadvantages that limit their daily use in clinical practice.

Areas covered: In patients with NVAF at risk of stroke, the randomized evaluation of long-term anticoagulation therapy (RE-LY) trial demonstrated that, compared with warfarin, dabigatran 150 mg b.i.d. was associated with lower rates of stroke and systemic embolism but similar rates of major hemorrhage, whereas dabigatran 110 mg b.i.d. exhibited similar rates of stroke and systemic embolism, but lower rates of major hemorrhage. Fortunately, data about dabigatran are not limited to RE-LY trial. In fact, many substudies have been drawn, providing new and important evidences about the benefits of dabigatran.

Expert opinion: The most recent evidences about efficacy and safety of dabigatran in patients with NVAF, focusing on different substudies of RE-LY trial, are reviewed. In summary, dabigatran is beneficial not only in general population with NVAF but also in different subgroups of patients or different clinical settings (i.e., CHADS2 score, INR control, type of AF, elderly, previous transient ischemic attack or stroke, cardioversion and so on).     

Anticoagulation in patients with non-valvular atrial fibrillation: an evaluation of stability and early factors that predict longer-term stability on warfarin in a large UK population

ABSTRACT

Objective: To determine the proportion of patients with non-valvular atrial fibrillation (NVAF) treated with warfarin that achieved a 6‐month period within the target INR range (stability). To then evaluate any associations between stability and outcome and to determine whether stability can be predicted by clinical factors at an early stage in warfarin treatment.

Methods: This study was a record linkage study in 1513 patients with NVAF treated with warfarin for a minimum of 6‐months, carried out in a large UK population. The main outcome measures were stability (defined as six months within the target INR range [2.0–3.0]), thromboembolic and bleeding event rates and mortality. Secondary outcome measures were the predictive value of baseline characteristics and other treatment variables.

Results: Stability was achieved in 52% of the study group. Standardised mean survival was significantly higher in the group who achieved stability (? = 16.91 months, p < 0.001) with a hazard ratio of 4.36 (?p < 0.001). The stable group had a lower rate of both thromboembolic events (0.8% vs. 2.3% per patient year) and bleeds recorded on inpatient diagnoses (0.4% vs. 1.2% per patient year). Failure to achieve stable control was associated with age (Odds Ratio [OR] 1.011 (95% Confidence Interval [CI] 1.001–1.021)) and morbidity at baseline (OR 1.015; 95% CI 1.007–1.022). An increase in mean time between visits (OR 0.939; 95% CI 0.926–0.952) and the percentage time in range (OR 0.889; 95% CI 0.879–0.900) was associated with a decrease in the chance of instability. Greater variability in INR was also associated with a failure to achieve stability (OR 1.518; 95% CI 1.427–1.615). Receiver Operator Characteristic (ROC) analysis using data from the first three months of treatment demonstrated good discrimination of stability using age and morbidity at baseline and percentage time in range and frequency of visits during the first three months of treatment (area under curve [AUC] 0.780; standard error [SE] 0.012; 95% CI 0.757–0.803).

Conclusions: Many patients never achieved a period of 6‐months stability and were at increased risk of thromboembolic events and bleeds. Age, morbidity at baseline and variability of INR control in the first three months could be used to predict instability using warfarin. This study infers that patients should be treated more intensively in the early stages of warfarinisation in order to improve outcome.     

银杏达莫注射液联合华法林治疗急性高危肺栓塞的临床研究

目的探讨银杏达莫注射液联合华法林治疗急性高危肺栓塞的临床效果。方法选取2015年3月—2018年3月平山县人民医院收治的78例急性高危肺栓塞患者,随机分为对照组(39例)和治疗组(39例)。对照组口服华法林钠片,初始剂量为2.5 mg/d,连用5d后按照国际标准化比值(INR)调整剂量,最佳抗凝目标范围为INR达2.0～3.0。治疗组在对照组的基础上静脉滴注银杏达莫注射液,20 mL溶于生理盐水500 mL,2次/d。两组均连续治疗14 d。观察两组患者临床疗效,同时比较治疗前后两组主要症状缓解情况、血气指标、纤溶系统指标、血小板、右心功能参数变化情况。结果治疗后,治疗组总有效率为92.3%,显著高于对照组的74.4%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组主要症状呼吸困难、胸痛、紫绀、低血压和单侧肢体肿胀的缓解时间较对照组均显著缩短,两组比较差异具有统计学意义(P0.05)。治疗后,两组动脉血氧(p O2)和二氧化碳分压(p CO2)值均显著升高,肺泡–动脉血氧梯度(A-aDO2值)、D-二聚体(D-D)和纤维蛋白原降解产物(FDP)水平、血小板分布宽度(PDW)、平均血小板体积(MPV)、肺动脉收缩压(PASP)、右心室横径(RVTD)和右心房横径(RAd)均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组这些观察指标明显优于对照组,两组比较差异有统计学意义(P0.05)。结论银杏达莫注射液联合华法林治疗急性高危肺栓塞疗效显著,能明显减轻患者症状,改善血气状态,调节纤溶功能及血小板功能,增强右心功能,具有一定临床推广应用价值。     

基于临床参考及基因因素建立华法林稳定维持剂量预测模型

目的 探讨华法林应用的临床参考因素及基因因素与华法林稳定维持剂量的相关性,并尝试构建适用于非瓣膜病心房纤颤（non-valvular-disease atrial fibrillation,NVAF）患者华法林稳定维持剂量的预测模型。方法 按照纳入标准共纳入126例患者,应用测序反应通用试剂盒及荧光检测仪检测细胞色素P450 2C9和维生素K环氧化物还原酶基因多态性,同时记录华法林应用的临床参考因素：年龄、体质量、房颤栓塞风险评分系统（CHA₂DS₂-VASc）评分、房颤出血风险评分系统（HAS-BLED）评分、谷丙转氨酶（glutamic-pyruvic transaminase,ALT）、肾小球滤过率（glomerular filtration rate,GFR）、左心室射血分数（left ventricular ejection fraction,LVEF）、二尖瓣环水平左室侧壁组织多普勒S波;采用相关性分析探讨临床参考因素及基因多态性与华法林稳定维持剂量的相关性,并通过多元线性回归建立了华法林稳定维持剂量预测模型。结果 体质量、ALT水平、二尖瓣环水平左室侧壁组织多普勒S波与华法林稳定维持剂量成正相关,年龄、CHA₂DS₂-VASc评分、HAS-BLED评分则成负相关,而LVEF、GFR未显示明显的相关性。建立的预测模型对已有样本验证准确率达55.6%。结论 该模型可用于预测NVAF患者华法林稳定维持剂量。