Albers G W, Atwood J E, Hirsh J, Sherman D G, Hughes R A, Connolly S J
Palo Alto Veterans Affairs Medical Center, CA 94304.
Ann Intern Med. 1991 Nov 1;115(9):727-36. doi: 10.7326/0003-4819-115-9-727.
There has been considerable uncertainty about the best way to prevent stroke in patients with nonvalvular atrial fibrillation. Recent studies have suggested that low-dose warfarin therapy, in addition to producing fewer bleeding complications, may be as effective as higher-dose therapy in preventing thromboembolic events. Four large, prospective, randomized trials have examined the risks and benefits of warfarin therapy for stroke prophylaxis in patients with nonvalvular atrial fibrillation. All four studies showed a substantially reduced incidence of stroke and a low incidence of significant bleeding in patients treated with warfarin. One of these studies also showed that aspirin reduced the incidence of stroke. The benefits associated with long-term low-dose warfarin therapy appear to exceed the risks for serious bleeding in most patients with atrial fibrillation. Aspirin may be a viable therapeutic option for patients who are unable to take warfarin or for those in subgroups at a low risk for stroke.
对于非瓣膜性心房颤动患者预防中风的最佳方法，一直存在相当大的不确定性。最近的研究表明，低剂量华法林治疗除了产生较少的出血并发症外，在预防血栓栓塞事件方面可能与高剂量治疗一样有效。四项大型前瞻性随机试验研究了华法林治疗对非瓣膜性心房颤动患者预防中风的风险和益处。所有四项研究均显示，接受华法林治疗的患者中风发生率大幅降低，严重出血发生率较低。其中一项研究还表明阿司匹林可降低中风发生率。对于大多数心房颤动患者而言，长期低剂量华法林治疗的益处似乎超过严重出血的风险。对于无法服用华法林的患者或中风风险较低亚组的患者，阿司匹林可能是一种可行的治疗选择。
