抗Ⅹa因子活性测定用于80岁及以上高龄患者口服利伐沙班的监测  

Anti-FⅩa activity measurement for monitoring oral rivaroxaban in elderly patients aged 80 and over

作　　者：沈姞[1] 李传保[2] 朱愿超[3] 武文斌[1] 刘洋[1] 袁莹[1] 李晶[1] 施红[1] Shen Ji;Li Chuanbao;Zhu Yuanchao;Wu Wenbin;Liu Yang;Yuan Ying;Li Jing;Shi Hong(Department of Geriatrics,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Clinical Laboratory,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pharmacy,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院老年医学科,国家老年医学中心,中国医学科学院老年医学研究院,100730 [2]北京医院老年医学科,国家老年医学中心,中国医学科学院老年医学研究院检验科,100730 [3]北京医院老年医学科,国家老年医学中心,中国医学科学院老年医学研究院药学部,100730

出　　处：《中国心血管杂志》2020年第4期306-311,共6页Chinese Journal of Cardiovascular Medicine

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2020-04-20)。

摘　　要：目的探讨在口服利伐沙班的80岁及以上高龄患者中监测抗Ⅹa因子活性的意义。方法纳入2019年北京医院老年医学科高龄非瓣膜病心房颤动和静脉血栓栓塞症患者23例,口服利伐沙班抗凝治疗至少4 d后测定其抗Ⅹa因子活性的谷峰浓度,并进行服药依从性和血栓、出血等事件的随访。结果在23例高龄患者中,非瓣膜病心房颤动19例,静脉血栓栓塞症4例。利伐沙班服用剂量分别为15 mg/d 15例,10 mg/d 7例和5 mg/d 1例。监测抗Ⅹa因子活性,4例患者谷浓度大于200 ng/ml,8例患者峰浓度大于400 ng/ml(其中2例超过700 ng/ml),2例患者谷峰浓度差距较小。2例非瓣膜病心房颤动患者出院后自行停用利伐沙班,其他21例患者服药依从性较好。服药过程中3例出现黑便、便潜血阳性,1例出现血尿。19例非瓣膜病心房颤动患者抗凝过程中均未发生脑卒中事件;1例肺栓塞患者抗凝过程中再次出现下肢深静脉血栓;1例下肢深静脉血栓患者抗凝过程中发生急性心肌梗死。结论本研究中部分高龄患者抗Ⅹa因子活性的谷峰浓度明显高于国外报道水平,尤其是肾功能不全的患者,建议根据抗Ⅹa因子活性测定结果和临床不良事件调整利伐沙班剂量。Objective To investigate the clinical value of monitoring anti-FⅩa activity in patients aged 80 and over who take oral rivaroxaban.Methods Twenty-three elderly patients with non-valvular atrial fibrillation(NVAF)and venous thromboembolism(VTE)in the Department of Geriatrics,Beijing Hospital in 2019 were enrolled in this study.At least 4 days after rivaroxaban treatment,the extremal concentrations of anti-FⅩa activity were measured.Drug compliance,thrombosis,bleedings,and other events were followed up.Results The patients included 19 NVAF cases and 4 VTE cases.The dosage of rivaroxaban was 15 mg/d in 15 cases,10 mg/d in 7 cases and 5 mg/d in 1 case.For anti-FⅩa activity,we found that the trough concentrations of 4 patients were greater than 200 ng/ml,and the peak concentrations of 8 patients were greater than 400 ng/ml with two that above 700 ng/ml.Two patients had small differences between trough and peak concentrations.Rivaroxaban was discontinued in 2 patients with NVAF after discharge,and the other 21 had good compliances.Three patients had melena and positive fecal occult blood test,1 patient had hematuria,and the remaining 19 patients had no bleeding events.Nineteen patients with NVAF did not experience stroke during anticoagulation;1 patient with pulmonary embolism relapsed with deep vein thrombosis during anticoagulation;1 patient with acute myocardial infarction during anticoagulation with lower limb deep vein thrombosis.Conclusions The trough and peak concentrations of anti-FⅩa activity of some elderly patients in this study were significantly higher than the results reported abroad.For these patients,especially with renal insufficiency,it is recommended to adjust the dosage based on anti-FⅩa activity measurement and clinical adverse events.

关 键 词：老年人 80以上 利伐沙班 抗Ⅹa因子活性 

分 类 号：R969[医药卫生—药理学]