利伐沙班在高龄心力衰竭合并房颤抗凝治疗中的剂量优化研究  

Dose optimization of rivaroxaban in anticoagulant therapy for elderly patients with heart failure complicated with atrial fibrillation

作　　者：许宇文 刘琼[1] 沈琼 朱琰[1] 方宏钧[2] XU Yu-wen;LIU Qiong;SHEN Qiong;ZHU Yan;FANG Hong-jun(Department of Pharmacy,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China;Department of Cardiovascular Medicine,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)

机构地区：[1]上海中医药大学附属曙光医院药剂科,上海市200021 [2]上海中医药大学附属曙光医院心内科,上海市200021

出　　处：《实用老年医学》2022年第10期1028-1032,共5页Practical Geriatrics

摘　　要：目的研究利伐沙班在高龄心力衰竭合并心房颤动(房颤)抗凝治疗中的最佳剂量。方法回顾性收集2018年2月至2021年2月我院85例高龄(>80岁)心力衰竭合并房颤病人的临床资料,按照利伐沙班的处方剂量分为低剂量组(5 mg/d,n=25)、中剂量组(10 mg/d,n=41)和高剂量组(20 mg/d,n=19)。比较3组治疗前、治疗1个月后凝血功能指标[凝血酶原时间(PT)、D-二聚体(D-D)]及心功能指标[LVEF、肺动脉压(PAP)、N末端B型钠尿肽前体(NT-proBNP)],并随访6个月,统计栓塞事件及出血事件发生情况。结果治疗前、治疗后3组间PT、D-D比较,差异均无统计学意义(P>0.05);治疗后3组PT均长于治疗前,D-D水平均低于治疗前(P<0.05);治疗前、治疗后3组间LVEF、PAP、NT-proBNP比较,差异均无统计学意义(P>0.05);治疗后3组LVEF均大于治疗前,PAP、NT-proBNP水平均低于治疗前(P<0.05)。随访6个月,中剂量组栓塞事件发生率低于低剂量组(P<0.05),出血事件发生率低于高剂量组(P<0.05)。结论对于高龄心力衰竭合并房颤病人,采用利伐沙班治疗能改善凝血功能及心功能,且10 mg/d可能为高龄心力衰竭合并房颤病人抗凝治疗的最佳剂量。Objective To study the dose optimization of rivaroxaban in the anticoagulant treatment of heart failure complicated with atrial fibrillation in the patients aged>80 years.Methods The clinical data of 85 elderly patients with heart failure complicated with atrial fibrillation in our hospital from February 2018 to February 2021 were collected retrospectively.According to the prescription dose of rivaroxaban,they were divided into low dose group(5 mg/d,n=25),medium dose group(10 mg/d,n=41)and high dose group(20 mg/d,n=19).The indexes of coagulation function[prothrombin time(PT),D-dimer(D-D)]and cardiac function[left ventricular ejection fraction(LVEF),pulmonary artery pressure(PAP),N-terminal B-type natriuretic peptide precursor(NT-proBNP)]were compared before treatment and 1 month after treatment,and all patients were followed up for 6 months.Results There were no significant differences in PT and D-D between the three groups before and after treatment(P>0.05).After treatment,the level of PT was longer and the level of D-D was lower than that before treatment in the three groups(P<0.05).There were no significant differences in the levels of LVEF,PAP and NT-proBNP between the three groups before and after treatment(P>0.05).After treatment,the level of LVEF in the three groups was higher than that before treatment,and the levels of PAP and NT-proBNP were lower than those before treatment(P<0.05).In the middle dose group,the total embolism rate was lower than that in the low dose group(P<0.05),while the total incidence rate of bleeding was lower than that in the high dose group(P<0.05).Conclusions For elderly patients with heart failure complicated with atrial fibrillation,rivaroxaban can improve the coagulation function and cardiac function,and 10 mg/d may be the best dose of anticoagulant therapy.

关 键 词：高龄 心力衰竭 心房颤动 利伐沙班 剂量优化 

分 类 号：R541[医药卫生—心血管疾病]