利伐沙班与华法林治疗非瓣膜性房颤的临床效果比较  

Comparison of clinical effects of rivaroxaban and warfarin in the treatment of non-valvular atrial fibrillation

作　　者：曾令文[1] 王文凯[2] 陈德武 胡冲[1] ZENG Lingwen;WANG Wenkai;CHEN Dewu;HU Chong(Emergency Department,the Second People′s Hospital of Hainan Province,Hainan province,Wuzhishan 572299,China;不详)

机构地区：[1]海南省第二人民医院急诊科,海南省五指山市572299 [2]海南省第二人民医院心血管内科,海南省五指山市572299

出　　处：《临床合理用药杂志》2023年第8期1-3,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的比较利伐沙班与华法林治疗非瓣膜性房颤(NVAF)的临床效果。方法选取2019年6月—2020年12月海南省第二人民医院收治的NVAF患者120例,采用随机数字表法分为观察组和对照组,各60例。在常规治疗基础上,对照组予华法林钠片治疗,观察组在常规治疗基础上予利伐沙班片治疗,连续治疗6个月。比较2组栓塞(心肌梗死、下肢静脉栓塞、肺栓塞、缺血性脑卒中)、出血[轻微出血(痰中带血、牙龈出血)、少量出血(肉眼血尿、少量呕血、血便)及严重出血(脑出血、消化道大出血)],治疗前后相关血清指标[N末端脑钠肽前体(NT-proBNP)、D-二聚体(D-D)]水平。结果观察组与对照组栓塞总发生率比较差异无统计学意义(6.67%vs.10.00%,χ^(2)=0.436,P=0.509);观察组出血总发生率为1.67%,低于对照组的13.33%(χ^(2)=4.324,P=0.038);治疗后,2组NT-proBNP、D-D水平均较治疗前降低,但组间比较差异无统计学意义(P>0.05)。结论利伐沙班相较于华法林治疗NVAF,预防血栓栓塞优势与之相当,但利伐沙班出血发生率低于华法林,安全性相对较高,值得临床推广应用。Objective To compare the clinical effects of rivaroxaban and warfarin in the treatment of non-valvular atrial fibrillation(NVAF).Methods Select 120 patients with NVAF admitted to the Second People′s Hospital of Hainan Province from June 2019 to December 2020.The patients were divided into observation group and control group with 60 cases each by random number table.On the basis of routine treatment,the control group was treated with warfarin sodium tablets,and the observation group was treated with rivaroxaban tablets on the basis of routine treatment.Both groups were treated continuously for 6 months.The incidence of embolism(myocardial infarction,lower limb vein embolism,pulmonary embolism,ischemic stroke)was compared between the two groups.Compare the occurrence of bleeding,such as slight bleeding(blood in sputum,gingival bleeding),small amount of bleeding(gross hematuria,small amount of hematemesis,bloody stool)and severe bleeding(cerebral hemorrhage,gastrointestinal bleeding).And compare the changes of the relevant plasma indicators(NT-proBNP,D-D)before and after treatment.Results There was no statistically significant difference in the total incidence of embolism between the observation group and the control group(6.67%vs.10.00%,χ^(2)=0.436,P=0.509).The total incidence of bleeding in the observation group was 1.67%,lower than 13.33%in the control group(χ^(2)=4.324,P=0.038).After treatment,the levels of NT-proBNP and D-D in the two groups were lower than those before treatment,but there was no significant difference between the two groups(P>0.05).Conclusion Compared with warfarin in the treatment of NVAF,rivaroxaban has the same advantages in preventing thromboembolism.However,the incidence of hemorrhage of rivaroxaban is lower than that of warfarin,and its safety is relatively high,which is worthy of clinical application.

关 键 词：非瓣膜性房颤 利伐沙班 华法林 栓塞 出血 氨基末端脑钠肽前体 D-二聚体 

分 类 号：R541.75[医药卫生—心血管疾病]