非瓣膜性心房颤动合并肾功能不全患者应用利伐沙班的安全性和有效性临床观察  

Safety and efficacy of rivaroxaban in patients with non-valvular atrial fibrillation complicated by renal insufficiency

作　　者：许洪玲 肖军[2] 华宁[1] 王洪叶[1] Xu Hongling;Xiao Jun;Hua Ning;Wang Hongye(Department of Cardiovascular Medicine,Eighth Medical Center of Chinese PLA General Hospital,Beijing 100091,China;不详)

机构地区：[1]解放军总医院第八医学中心心血管内科,北京100091 [2]解放军总医院第八医学中心老年医学科,北京100091

出　　处：《中国循证心血管医学杂志》2022年第5期562-564,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：军事理论科研计划项目重点项目(JJ2021A06-B022);装备综合研究项目(LB2021EA010029)。

摘　　要：目的探究非瓣膜性心房颤动(房颤)合并肾功能不全患者应用利伐沙班抗凝的安全性和有效性。方法纳入2019年2月至2020年2月于解放军总医院第八医学中心心血管内科收治的非瓣膜性房颤合并肾功能不全患者80例,根据内生肌酐清除率(Ccr)分为轻度肾功能不全组(Ccr=50~70 ml/min,n=40)和中度肾功能不全组(Ccr=31~50 ml/min,n=40),分别予利伐沙班20 mg/d、15 mg/d抗凝治疗。检测两组患者治疗前、治疗1个月、3个月以及6个月凝血和肾功能指标、出血事件及不良事件发生率。结果相比于治疗前,两组患者治疗后1个月、3个月、6个月凝血酶原时间、活化部分凝血活酶时间、凝血酶时间延长(P<0.01);与治疗后1个月相比,治疗后3个月和6个月的凝血酶原时间、活化部分凝血活酶时间、凝血酶时间延长(P<0.01);治疗前后相比凝血酶原活动度、内生肌酐清除率、国际标准化比值及D-二聚体水平无显著差异(P>0.05)。两组患者治疗前后均未出现脑卒中、血栓栓塞及大出血事件。结论非瓣膜性房颤患者根据肾功能不同给予不同剂量的利伐沙班,其抗凝疗效显著且安全性高。Objective To discuss the anticoagulation safety and efficacy of rivaroxaban in patients with non-valvular atrial fibrillation(NVAF)complicated by renal insufficiency(RI).Methods The patients with NVAF complicated by RI(n=80)were chosen from Department of Cardiovascular Medicine in the Eighth Medical Center of Chinese PLA General Hospital from Feb.2019 to Feb.2020.According to creatinine clearance rate(CCr),the patients were divided into mild RI group(Ccr=50~70 ml/min,n=40)treated with 20 mg/d of rivaroxaban and moderate RI group(Ccr=31~50 ml/min,n=40)treated with 15 mg/d of rivaroxaban.The indexes of coagulation and renal function,and incidence rates of bleeding events and adverse events were detected before treatment and after treatment for 1 month,3 months and 6 months.Results After treatment for 1 month,3 months and 6 months,prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)were prolonged compared with before(P<0.01).Compared with those after treatment for 1 month,PT,APTT and TT were prolonged after treatment for 3 months and 6 months(P<0.01).The prothrombin activity(PTA),Ccr,international normalized ratio(INR)and level of D-dimer(D-D)had no significant differences before and after treatment(P>0.05).There were no stroke,thrombembolia and severe bleeding events observed in 2 groups.Conclusion Rivaroxaban,in different doses,is administrated in NVAF patients according to their renal function and has significant anticoagulant effect and higher safety.

关 键 词：利伐沙班 非瓣膜性房颤 肾功能不全 安全性 有效性 

分 类 号：R541.75[医药卫生—心血管疾病]