Zhongguo cuzhong zazhi (Mar 2023)
丁苯酞对华法林治疗心源性卒中患者抗凝作用的影响 Effect of Butylphthalein on Anticoagulation of Warfarin in Patients with Cardiogenic Stroke
Abstract
目的 探讨心源性卒中患者使用丁苯酞对华法林抗凝作用的影响。 方法 前瞻性连续纳入成都医学院第一附属医院神经内科2019年6月—2021年12月期间收治的心源性卒中患者，患者入组后随机分为试验组（华法林+丁苯酞）和对照组（华法林）。监测两组患者的国际标准化比值（international standardized ratio，INR）变化情况并收集两组患者的临床资料，比较分析两组患者的INR达标时间、2周内达标率和90 d mRS评分的差异。 结果 本研究共纳入101例心源性卒中患者，试验组51例，对照组50例。两组基线数据（年龄、性别、用药前INR、收缩压和舒张压）差异无统计学意义，入院时试验组的NIHSS评分[10（3.0～15.0）分 vs. 0（0～6.5）分，P<0.001]，溶栓率（27.5% vs. 8.0%，P=0.011）与取栓率（25.5% vs. 2.0%，P=0.001）均高于对照组。试验组INR 2周内达标率与对照组相比差异无统计学意义（43.1% vs. 44.0%，P=0.930）。试验组达标时间较对照组明显缩短[（6.50±2.41）d vs.（9.64±4.40）d，P=0.015]。试验组90 d mRS评分与对照组相比，差异无统计学意义[3（0.5～4.0）分 vs. 2（0～3.0）分，P=0.175]。 结论 丁苯酞联合华法林治疗心源性卒中可能缩短华法林的达标时间，需进一步的研究来验证，但对于INR的达标率和90 d mRS评分无影响。 Abstract: Objective To investigate the effect of butylphthalide on warfarin anticoagulation in patients with cardiogenic stroke. Methods The patients with cardiogenic stroke admitted to the Department of Neurology of the First Affiliated Hospital of Chengdu Medical College from June 2019 to December 2021 were consecutively enrolled in this prospective study. All the patients were randomly divided into observation group (warfarin+butylphthalide) and control group (warfarin). The changes of international standardized ratio (INR) and clinical data of the two groups were collected. The time of INR reaching the target, the rate of reaching the target within 2 weeks and the mRS score at 90 days were compared and analyzed between the two groups. Results A total of 101 subjects were included in this study, with 51 cases in each group. There were no statistical differences in the baseline data of age, gender, INR before treatment, systolic and diastolic blood pressure between the two groups. The NIHSS score at admission [10 (3.0-15.0) vs. 0 (0-6.5), P<0.001], and the proportionof thrombolytic and thrombectomy patients (27.5% vs. 8.0%, P=0.011; 25.5% vs. 2.0%, P=0.001) were higher than that in the control group. There was no statistical difference in the rate of INR reaching the target within 2 weeks between the two groups (43.1% vs. 44.0%, P=0.930). The time to reach the target in the observation group was shorter than that in the control group [(6.50±2.41) d vs. (9.64±4.40) d, P=0.015]. There was no statistical difference in mRS score at 90 days between the two groups [3 (0.5-4.0) vs. 2 (0-3.0) , P=0.175]. Conclusions Butylphthalide combined with warfarin in treatment of cardiogenic stroke may shorten the time to reach the target of warfarin, which needs further study to verify, while it had no effect on the rate of INR reaching the target and 90-day mRS score.
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