Kodani Eitaro, Atarashi Hirotsugu, Inoue Hiroshi, Okumura Ken, Yamashita Takeshi, Origasa Hideki
Department of Internal Medicine and Cardiology, Nippon Medical School, Tama-Nagayama Hospital.
Circ J. 2015;79(11):2345-52. doi: 10.1253/circj.CJ-15-0621. Epub 2015 Sep 1.
To clarify the effects of warfarin therapy in very old patients with non-valvular atrial fibrillation (NVAF), a post-hoc analysis was performed using the data of the J-RHYTHM Registry.
A consecutive series of AF outpatients was enrolled from 158 institutions. Of 7,937 patients, 7,406 with NVAF (men, 70.8%; 69.8±10.0 years) were followed for 2 years or until an event occurred. Patients were divided into 3 age groups (<70, 70-84, and ≥85 years) and 5 subgroups according to international normalized ratio (INR; <1.6, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0). Prevalence of female sex, permanent AF, hypertension, coronary artery disease, heart failure, and history of ischemic stroke/transient ischemic attack was higher in the older groups. In the oldest group, 79.7% of patients received warfarin and their time in therapeutic range, using the Japanese target INR of 1.6-2.6, was 67.1%. Rate of thromboembolic events was lower in the age groups <70 and 70-84 years (P=0.027 and P<0.001, respectively) for patients receiving warfarin compared with those who were not. In the oldest group, the rate of thromboembolism plus major hemorrhage was lower at INR 1.6-2.59.
Warfarin could have beneficial effects even in very old NVAF patients if INR is kept between 1.6 and 2.59.
为阐明华法林治疗对高龄非瓣膜性心房颤动（NVAF）患者的影响，我们利用J-RHYTHM注册研究的数据进行了一项事后分析。
连续纳入来自158家机构的房颤门诊患者。在7937例患者中，7406例NVAF患者（男性占70.8%；年龄69.8±10.0岁）随访2年或直至发生事件。根据国际标准化比值（INR；<1.6、1.6-1.99、2.0-2.59、2.6-2.99和≥3.0）将患者分为3个年龄组（<70岁、70-84岁和≥85岁）和5个亚组。老年组女性、永久性房颤、高血压、冠状动脉疾病、心力衰竭以及缺血性中风/短暂性脑缺血发作病史的患病率更高。在最年长组中，79.7%的患者接受了华法林治疗，按照日本的目标INR为1.6-2.6计算，他们处于治疗范围内的时间为67.1%。接受华法林治疗的<70岁和70-84岁年龄组患者的血栓栓塞事件发生率低于未接受治疗的患者（分别为P=0.027和P<0.001）。在最年长组中，INR为1.6-2.59时血栓栓塞加重大出血的发生率较低。
如果将INR维持在1.6至2.59之间，华法林即使对高龄NVAF患者也可能有益。
