Mendelson G, Aronow W S
Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York, USA.
J Am Geriatr Soc. 1998 Nov;46(11):1423-4. doi: 10.1111/j.1532-5415.1998.tb06011.x.
To investigate the prevalence of the use of warfarin to maintain an international normalized ratio (INR) between 2.0 and 3.0 in older persons with chronic nonvalvular atrial fibrillation (AF), and without contraindications to warfarin, who are at high risk for developing new thromboembolic (TE) stroke.
A retrospective analysis of charts from all older persons seen during 1997 at an academic hospital-based geriatrics practice.
An academic hospital-based geriatrics practice staffed by fellows in a geriatrics training program and full-time faculty geriatricians.
Three hundred eighty men and 1183 women, mean age 80+/-8 years (range 59 to 103 years), were included in the study.
Of 1563 persons studied, 141 (9%) had chronic nonvalvular AF. Of 141 persons with AF, 127 (90%) were at high risk for developing TE stroke because they had either a previous thromboembolism, congestive heart failure, or echocardiographic evidence of abnormal left ventricular systolic function; a systolic blood pressure >160 mm Hg; or they were women older than 75 years of age. Of the 127 persons with AF at high risk for developing TE stroke, three (2%) had contraindications to warfarin. Of the 124 persons with AF at high risk for developing TE stroke and no contraindications to warfarin, 61 (49%) were treated with warfarin to maintain an INR between 2.0 and 3.0, and 45 (36%) were treated with 325 mg aspirin daily. Of 14 persons with AF at low risk for developing TE stroke, one (7%) was treated with warfarin to maintain an INR between 2.0 and 3.0, and six (43%) were treated with 325 mg aspirin daily.
Warfarin is underutilized as a treatment to maintain an INR between 2.0 and 3.0 in older persons with chronic nonvalvular AF at high risk for developing TE stroke.
调查在患有慢性非瓣膜性心房颤动（AF）、无华法林使用禁忌且有发生新的血栓栓塞性（TE）中风高风险的老年人中，使用华法林将国际标准化比值（INR）维持在2.0至3.0之间的比例。
对1997年在一家学术医院老年医学诊所就诊的所有老年人的病历进行回顾性分析。
一家学术医院的老年医学诊所，由老年医学培训项目的研究员和全职老年科医生组成。
380名男性和1183名女性纳入研究，平均年龄80±8岁（范围59至103岁）。
在1563名研究对象中，141人（9%）患有慢性非瓣膜性AF。在141名AF患者中，127人（90%）有发生TE中风的高风险，因为他们既往有血栓栓塞、充血性心力衰竭，或有左心室收缩功能异常的超声心动图证据；收缩压>160 mmHg；或者是年龄大于75岁的女性。在127名有发生TE中风高风险的AF患者中，3人（2%）有华法林使用禁忌。在124名有发生TE中风高风险且无华法林使用禁忌的AF患者中，61人（49%）接受华法林治疗以维持INR在2.0至3.0之间，45人（36%）每天服用325 mg阿司匹林。在14名发生TE中风低风险的AF患者中，1人（7%）接受华法林治疗以维持INR在2.0至3.0之间，6人（43%）每天服用325 mg阿司匹林。
在有发生TE中风高风险的慢性非瓣膜性AF老年人中，华法林作为一种将INR维持在2.0至3.0之间的治疗方法未得到充分利用。
