低剂量利伐沙班在老年非瓣膜性房颤治疗中的效果观察  

Observation of low dose rivaroxaban in the treatment of non-valvular atrial fibrillation in elderly

作　　者：艾阳[1] 李必龙[1] 朱春甲[1] 汪坤[1] 吴方斌[1] AI Yang;LI Bi-long;ZHU Chun-jia;WANG Kun;WU Fang-bin(Department of Cardiology,Tongling People’s Hospital,Tongling 244000,China)

机构地区：[1]铜陵市人民医院心内科二病区,安徽省铜陵市244000

出　　处：《实用老年医学》2020年第7期666-669,共4页Practical Geriatrics

基　　金：安徽省铜陵市卫生计生委2018年科研立项项目[卫科研(2018)12号]。

摘　　要：目的比较低剂量利伐沙班与华法林对老年非瓣膜性房颤病人的抗凝效果及安全性。方法选择本院2018年1月至2019年3月收治的66例老年非瓣膜性房颤病人,随机分成低剂量利伐沙班组(33例)及华法林组(33例)。低剂量利伐沙班组给予10 mg/d利伐沙班;华法林组华法林的起始剂量为1.25~2.50 mg/d,根据监测的国际标准化比值(INR)调整剂量,目标INR为2.0~3.0。观察治疗1、3、6、9个月后2组Hb、RBC、PLT、凝血酶原时间(PT),并比较2组出血事件和不良反应发生率、新发缺血性脑卒中发生率,评价被动就诊率。结果2组病人时间主效应和治疗方法主效应差异均无统计学意义(P>0.05);且时间和方法的交互作用不显著(P>0.05)。低剂量利伐沙班组内脏/颅内出血和新发缺血性脑卒中发生率均为0,华法林组内脏/颅内出血和新发缺血性脑卒中发生率均为3.03%,差异无统计学意义(P>0.05);2组皮肤/黏膜出血、血尿、黑便、呕血和不良反应发生率差异无统计学意义(P>0.05);2组的被动就诊率差异亦无统计学意义(P>0.05)。结论老年非瓣膜性房颤病人在预防缺血性脑卒中选择口服抗凝药时,低剂量利伐沙班具有和华法林相似的疗效。Objective To compare the efficacy and safety of low dose rivaroxaban and warfarin in the treatment of non-valvular atrial fibrillation(AF)in the elderly patients.Methods A total of 69 elderly patients with non-valvular AF admitted to the hospital from January 2018 to March 2019 were randomly divided into low-dose rivaroxaban group(36 cases)and warfarin group(33 cases).Low-dose rivaroxaban group was given 10 mg/d rivaroxaban.Warfarin group was treated with warfarin at a dose of 1.25-2.50 mg/d;the international normalized ratio(INR)was monitored,and adjusted the dose with a target INR of 2.0-3.0.The levels of hemoglobin(Hb),red blood cell(RBC),platelets(PLT)and prothrombin time(PT)were observed after 3 months,6 months and 9 months of treatment.The incidences of bleeding events,adverse reactions and new ischemic stroke were counted,and the rate of passive treatment was evaluated.Results There were no significant differences in the main effects of time and treatment between the two groups(P>0.05),and the interaction between time and treatment was not significant.The incidences of visceral/intracranial hemorrhage and new ischemic stroke in the lowdose rivaroxaban group were nil,and those in the warfarin group were both 3.03%(P>0.05).The incidences of skin/mucosal bleeding,hematuria,melena,vomiting and adverse reactions of the two groups showed no significant differences(P>0.05).The rate of passive medical treatment showed no significant difference in both groups(P>0.05).Conclusions Compared with warfarin,low-dose rivaroxaban has similar efficacy in the prevention of non-valvular AF in the elderly.

关 键 词：利伐沙班 华法林 房颤 出血 脑卒中 

分 类 号：R541.4[医药卫生—心血管疾病]