文档介绍：口服抗凝治疗中国人的剂量及出血并发症北京大学人民医院心脏中心孙艺红长期口服抗凝治疗的常见疾病?心房颤动?二尖瓣狭窄或机械瓣膜置换?心室附壁血栓?深静脉血栓?肺栓塞?其他凝血因子ⅡⅦⅨⅩ-reductase- -reductase -warfarin相对抵抗蛋白S 蛋白C华法林的局限性?剂量反映差异大?每个人的剂量不同?与药物和食物的相互作用?治疗窗口窄?需要监测?半衰期长Hylek EM, et al. NEJM 1996;335:540- EM, et al. NEJM 1996;335:540-546. EM, et al. NEJM 1996;335:540- below results in a higher risk of stroke华法林抗凝的最低有效强度Hylek, et al, studied the risk of intracranial hemorrhage in outpatients treated with warfarin. They determined that an intensity of anticoagulation expressed as a prothrombin time ratio (PTR) above (roughly corresponding to an INR of to ) resulted in an increase in the risk of from: Adapted from: HylekHylek EM, Singer DE, Ann EM, Singer DE, Ann IntInt Med Med 1994;120:897-9021994;120:897-902VTE长期治疗的华法林抗凝强度研究者INR N VTE复发(%)严重出血(%) et et et et - 255 - 369 - 369 - 58 - 56 - 55 - 54 人工心脏瓣膜多数机械瓣膜INR - - 主动脉瓣二叶式机械瓣INR - 瓣膜类型ESC第一代INR - - - Relative risk reductionRelative risk reduction(95% CI)(95% CI)AFASAK I SPAF BAATAF CAFASPINAF EAFT All trials (n=6)AFASAK I SPAF BAATAF CAFASPINAF EAFT All trials (n=6)WarfarinWarfarinbetterbetterWarfarinWarfarinworseworse100100505000-50-50-100-100%%69%严重出血NS轻微出血3%