利伐沙班用于HASBLED评分≥3分的高龄非瓣膜性心房颤动患者的有效性和安全性  

Efficacy and safety of rivaroxaban therapy in elderly patients with non-valvular atrial fibrillation who had a HASBLED score≥3

作　　者：王奕涵 秦旭雁 韩宣泽 王樱洁 高菲菲 陈春红[2] 张岭楠 张芳[2] Wang Yihan;Qin Xuyan;Han Xuanze;Wang Yingjie;Gao Feifei;Chen Chunhong;Zhang Lingnan;Zhang Fang(Department of Medicine,Hebei University,Baoding 071000,China;Department of Cardiology,Affiliated Hospital of Hebei University,Baoding 071000,China)

机构地区：[1]河北大学医学部,河北保定071000 [2]河北大学附属医院心血管内科,河北保定071000

出　　处：《临床荟萃》2024年第2期121-124,共4页Clinical Focus

基　　金：河北省卫健委项目房颤患者射频消融术后早期复发与肠道微生物及代谢物关系(20242064)。

摘　　要：目的前瞻性探讨高龄HASBLED≥3分的非瓣膜性心房颤动(atrial fibrillation,AF)患者应用利伐沙班抗凝治疗的有效性和安全性。方法收集2023年2-9月住院的75岁以上使用利伐沙班抗凝治疗的非瓣膜性AF患者(HASBLED评分≥3分)90例,分为低剂量组(10 mg/d),常规剂量组(15 mg/d)。随访6个月,有效终点事件:缺血性脑卒中、外周动脉栓塞,安全终点事件:大出血和临床有意义的小出血,小出血包括皮下淤血、牙龈出血、血尿、便潜血阳性、眼结膜出血。结果①低剂量组CHA2DS2-VASc评分和HASBLED评分均高于常规剂量组,差异有统计学意义(P<0.05)。②两组治疗前凝血指标比较差异无统计学意义(P>0.05)。③随访6个月,两组均未见到新发缺血性脑卒中、外周栓塞事件。常规剂量组便潜血阳性3例,牙龈出血2例,皮下瘀斑3例。结论高龄HASBLED≥3分的非瓣膜性AF患者应用低剂量利伐沙班抗凝治疗有效、安全。Objective The aim of this study was to prospectively evaluate the efficacy and safety of rivaroxaban in the treatment of elderly patients with non-valvular atrial fibrillation(NVAF)who had a HASBLED score≥3.Methods A total of 90 patients over 75 years old with NVAF(HASBLED score≥3)treated with rivaroxaban from February to September in 2023,they were divided into low dose group(10 mg/d)and conventional dose group(15 mg/d).A 6-month follow-up was performed,the end points of primary efficacy were ischemic stroke,peripheral arterial embolism.The major bleeding was as a safety end point,including clinically significant minor bleeding,small bleeding as subcutaneous congestion,gingival bleeding,hematuria,occult blood positive stool,conjunctival bleeding.Results The scores of CHA2DS2-VASc and HASBLED in low dose group were significantly higher than those in conventional dose group(P<0.05).There was no significant difference in coagulation index between the two groups before treatment(P>0.05).During the 6-month follow-up,no new ischemic stroke and peripheral embolic events were observed in the low dose group and conventional dose group.There were 3 cases of occult blood positive stool,2 cases of gingival bleeding and 3 cases of subcutaneous ecchymosis in conventional dose group.Conclusion Low-dose rivaroxaban anticoagulation therapy is effective and safety in elderly NVAF patients who HASBLED score≥3,which provides theoretical basis for clinical application.

关 键 词：心房颤动 高龄 HASBLED评分 利伐沙班 抗凝治疗 

分 类 号：R541.75[医药卫生—心血管疾病]