小剂量利伐沙班治疗缺血和出血双高危老年非瓣膜性心房颤动的疗效及安全性分析  

Efficacy and safety analysis of low-dose rivaroxaban in the treatment of elderly patients with double high risk of ischemia and bleeding with non-valvular atrial fibrillation

作　　者：李楠兮 敖勇[2] 赵静 程标[1] 陈晓涵[1] LI Nan-xi;AO-Yong;ZHAO Jing;CHENG Biao;CHEN Xiao-han(Department of Geriatrics,Sichuan Academy of Medical Sciences&Sichuan Provincial People′s Hospital,Chengdu 610072,China;Deaprtment of Cardiology,Yilong County People′s Hospital,Nanchong 637699,China)

机构地区：[1]四川省医学科学院·四川省人民医院老年医学科,四川成都610072 [2]四川省仪陇县人民医院心内科,四川南充637699

出　　处：《实用医院临床杂志》2023年第4期141-144,共4页Practical Journal of Clinical Medicine

基　　金：四川省干部保健科研课题资助项目(编号:川干研2019-203)。

摘　　要：目的评价小剂量利伐沙班治疗缺血和出血双高危老年非瓣膜性房颤患者的疗效及安全性。方法纳入2019~2021年四川省人民医院收治的老年非瓣膜性房颤患者,符合CHA_(2)DS_(2)-VASC评分≥2分、HAS-BLED评分≥3分、eGFR在15~49 ml/(min·1.73 m^(2)),随机分为小剂量利伐沙班组(10 mg/d)、标准剂量利伐沙班组(15 mg/d)、华法林组,每组各100例,随访12个月,比较三组的疗效及安全性。结果治疗前后,三组肝肾功能比较,差异无统计学意义(P>0.05)。小剂量利伐沙班组的轻微出血事件及全部出血事件率均小于华法林组(P<0.05)。标准剂量利伐沙班组与华法林组的轻微出血事件及全部出血事件发生率比较,差异无统计学意义(P>0.05)。三组在缺血性卒中、非中枢神经系统的系统性栓塞、急性心肌梗死发生率、全因死亡率、大出血事件比较,差异无统计学意义(P>0.05)。结论小剂量利伐沙班在缺血和出血双高危的老年非瓣膜性房颤人群中的出血风险明显低于华法林,且抗凝治疗效果较华法林及标准剂量利伐沙班无明显差异。Objective To evaluate the effectiveness and safety of low-dose rivaroxaban in elderly patients with high risk of ischemia and hemorrhage with non-valvular atrial fibrillation(NVAF).Methods Elderly patients with NVAF in Sichuan Provincial People′s Hospital from 2019 to 2021 were enrolled.The patients with CHA_(2)DS_(2)-VASC score≥2,HAS-BLED score≥3,and eGFR 15~49 ml/(min·173m^(2))were divided into a low-dose rivaroxaban group(10mg/day),standard-dose rivaroxaban group(15mg/day)and warfarin group,100 in each group.The efficacy and safety of the three groups were compared after 12 months follow-up.Results There was no significant difference in the hepatic and renal function among the three groups before and after treatment(P>0.05).The rates of minor bleeding events and total bleeding events in the low-dose rivaroxaban group were significantly lower than those in the warfarin group(P<0.05).There was no significant difference between the standard-dose rivaroxaban and Warfarin groups in the incidence of minor bleeding events and total bleeding events(P>0.05).There were no significant differences in the incidence of ischemic stroke,non-central nervous system embolism(NCNS)and acute myocardial infarction(AMI),all-cause mortality and major bleeding events among the three groups.Conclusions The bleeding risk of low-dose rivaroxaban is significantly lower than warfarin in this elderly population.There is no significant difference in anticoagulant effect among the three groups(P>0.05).

关 键 词：小剂量利伐沙班 非瓣膜性心房颤动 卒中 出血 

分 类 号：R453[医药卫生—治疗学]