达比加群对非瓣膜性房颤卒中二级预防的疗效及安全性观察  

Efficacy and safety of dabigatran for secondary prevention of stroke in patients with non-valvular atrial fibrillation

作　　者：郑杨琴 殷为勇[1] 周成业[1] 

机构地区：[1]温州医科大学附属第一医院神经内一科,浙江温州325015

出　　处：《温州医科大学学报》2016年第5期383-387,共5页Journal of Wenzhou Medical University

摘　　要：目的：比较达比加群和华法林对非瓣膜性房颤卒中二级预防的疗效及安全性。方法：连续收集2013年1月1日至2015年1月28日在温州医科大学附属第一医院神经内科的非瓣膜性房颤伴缺血性卒中患者并根据其抗凝药物的不同分为达比加群组和华法林组,随访至2015年5月31日。纳入统计的有达比加群组78例,服用达比加群胶囊每日2次,每次110 mg;华法林组86例,服用华法林,维持监测国际标准化比值（INR）为2.0~3.0。比较2组血栓栓塞事件、出血事件的发生率。结果：华法林组发生血栓栓塞事件11例,达比加群组3例,2组比较差异有统计学意义（P〈0.05）;达比加群组消化道出血5例,颅内出血3例,华法林组消化道出血2例,颅内出血5例,2组比较差异无统计学意义（P〉0.05）;Has-bled评分是华法林严重出血的危险因素（P〈0.05）,不是达比加群的危险因素（P〉0.05）。结论：达比加群可以有效减少非瓣膜性房颤伴卒中患者再发血栓栓塞事件。同时,Has-bled评分不一定适用于评估服用达比加群进行二级预防抗凝的出血风险。Objective： To compare dabigatran and warfarin for secondary stroke prevention in nonvalvu-lar atrial fibrillation patients in efficacy and safety. Methods： Patients diagnosed as ischemic stroke with NVAF in our hospital from January 2013 to January 2015 were continuously reviewed, which were divided into two groups, anticoagulated with dabigatran 110 mg twice daily and adjusted-dose warfarin. The occurrence of stroke and systemic embolism, any bleeding, adverse reactions were recorded. Results： Systemic embolism occurred in 11 patients on warfarin compared with 3 on dabigatran （P〈0.05 for noninferiority）. Has-bled was a predictor of major bleeding on warfarin （P〈0.05）, but not of dabigatran （P〉0.05）. Conclusion： In patients with NVAF, dabi- gatran given at a dose of 110 mg is associated with lower rates of systemic embolism. Has-bled may be not suit- able for dabigatran, and it needs to be refined.

关 键 词：非瓣膜性房颤 卒中 达比加群 华法林 Has-bled评分 

分 类 号：R743.32[医药卫生—神经病学与精神病学]