目的：观察在CHADS2评分为1分的持续性非瓣膜病心房颤动（房颤）患者华法林和阿司匹林预防缺血性脑卒中的疗效与安全性。方法选择于2012年1月至2013年6月于陕西省人民医院心内科就诊的房颤患者，按照纳入标准共选择460例CHADS2评分为1分的患者，将其以1：1随机划分为华法林组（试验组）和阿司匹林组（对照组）。观察两组患者卒中的发生率及出血并发症的差异。结果平均随访（11.3±4.7）月，华法林组未观察到缺血性卒中发生，阿司匹林组缺血性卒中发生率为2.7%（6/225），华法林组缺血性卒中事件发生率明显低于阿司匹林组，差异有统计学意义（OR=1.027，95%CI：1.005~1.050，P=0.030）。华法林组轻度出血发生率为4.2%（9/216），多于阿司匹林组（0.9%，2/225），差异有统计学意义（OR=4.848，95%CI：1.035~12.699，P=0.033）；华法林组与对照组颅内出血发生率相近，无统计学差异（OR=1.042，95%CI：0.065~8.762，P＜0.05）。结论对CHADS2评分为1分的低危房颤患者，与阿司匹林比较，华法林导致微出血的发生率增高，但华法林能够有效降低缺血性卒中的发生率。%Objective To observe the curative effect and safety of warfarin and aspirin for preventing ischemia stroke in patients with persistent nonvalvular atrial fibrillation (NVAF) with 1 score of CHADS2 score. Methods The patients (n=460) were chosen from Jan. 2012 to Jun. 2013, and divided randomly into warfarin group (test group) and aspirin group (control group). The difference in stroke incidence and bleeding complications were observed between 2 groups. Results The average follow-up period was (11.3±4.7) m. There was no case of ischemia stroke in warfarin group, and incidence of ischemia stroke was 2.7%(6/225) in aspirin group (OR=1.027, 95%CI:1.005-1.050, P=0.030). The incidence of mild bleeding was 4.2%(9/216) in warfarin group and 0.9%(2/225) in aspirin group (OR=4.848, 95%CI:1.035-12.699, P=0.033). The incidence of intracranial hemorrhage was similar in 2 groups without statistical difference (OR=1.042, 95%CI:0.065-8.762, P<0.05). Conclusion Warfarin can increase the incidence of mild bleeding but reduce effectively the incidence of ischemia stroke compared with aspirin in patients with NVAF with 1 score of CHADS2 score.
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