Silva-Smith A
Nurse Pract. 1994 Feb;19(2):38-9, 43-4. doi: 10.1097/00006205-199402000-00012.
Strokes are responsible for significant morbidity and mortality. Persons who have chronic atrial fibrillation are at higher risk of having a stroke. Previously, anticoagulation with warfarin was instituted only in persons with atrial fibrillation associated with valvular problems. More recently, five studies have shown a clear benefit to using warfarin in persons with atrial fibrillation related to nonvalvular conditions, such as hypertension, coronary artery disease, and heart failure. Patients who were given warfarin in therapeutic dosages, as measured by prothrombin time ratios and International Normalized Ratios (INRs), had a significant reduction in stroke risk ranging from 37 to 79% in the five studies. The outcomes of these five studies have changed the way persons with chronic, nonvalvular atrial fibrillation are managed. Health care providers play a key role in the counseling of patients who are considering the use of warfarin, the patient education regarding potential complications and drug interactions, and the ongoing monitoring and laboratory testing needed for dosage adjustments.
中风是导致严重发病和死亡的原因。患有慢性心房颤动的人中风风险更高。以前，仅对伴有瓣膜问题的心房颤动患者采用华法林进行抗凝治疗。最近，五项研究表明，在患有与非瓣膜性疾病相关的心房颤动的患者中使用华法林有明显益处，这些非瓣膜性疾病如高血压、冠状动脉疾病和心力衰竭。在这五项研究中，通过凝血酶原时间比率和国际标准化比率（INR）测量，接受治疗剂量华法林的患者中风风险显著降低，降低幅度在37%至79%之间。这五项研究的结果改变了慢性非瓣膜性心房颤动患者的管理方式。医疗保健提供者在为考虑使用华法林的患者提供咨询、对患者进行有关潜在并发症和药物相互作用的教育，以及进行剂量调整所需的持续监测和实验室检测方面发挥着关键作用。
