10 mg/d与15 mg/d利伐沙班在75岁及以上非瓣膜性心房颤动患者中的应用  

Application of 10 mg/d and 15 mg/d Rivaroxaban in Nonvalvular Atrial Fibrillation Patients Aged 75 Years and above

作　　者：禹越 杨伟[2] 杜彬 钱荣凯 郑涛 苏显明[2] 吴岳[1] YU Yue;YANG Wei;DU Bin;QIAN Rongkai;ZHENG Tao;SU Xianming;WU Yue(Department of Cardiology,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,Shaanxi,China;Department of Geriatric Cardiology,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,Shaanxi,China)

机构地区：[1]西安交通大学第一附属医院心血管内科,西安710061 [2]西安交通大学第一附属医院老年心血管内科,西安710061

出　　处：《中国分子心脏病学杂志》2024年第2期5964-5969,共6页Molecular Cardiology of China

基　　金：国家重点研发计划(2019YFA0802300)。

摘　　要：目的比较10 mg/d及15 mg/d利伐沙班在老年非瓣膜性心房颤动治疗中的有效性及安全性,同时探寻影响有效性及安全性事件发生的相关因素。方法选择2019年1月至2021年12月于西安交通大学第一附属医院就诊的75岁及以上非瓣膜性心房颤动患者259例。根据出院时口服利伐沙班剂量的不同,分为10 mg/d组(167例)与15 mg/d组(92例)。对患者进行1年随访并记录死亡、缺血性脑卒中及出血事件的情况。分析利伐沙班剂量选择及结局事件发生的影响因素。结果两组患者的死亡、缺血性脑卒中事件及出血事件发生率相比较,差异无统计学意义(P均>0.05)。随着年龄增加,10 mg/d利伐沙班更被推荐(OR=0.866,95%CI:0.807~0.929,P<0.001)。存在心力衰竭(OR=3.783,95%CI:1.355~10.561,P<0.05)、心肌梗死(OR=5.287,95%CI:1.692~16.525,P<0.01)的患者更易发生死亡或缺血性脑卒中事件。既往存在肿瘤(OR=6.389,95%CI:1.772~23.029,P<0.01)的患者更易发生出血事件。结论10 mg/d与15 mg/d利伐沙班具有同样的安全性及有效性。对伴有心力衰竭、心肌梗死及肿瘤的心房颤动患者需加强预防管理,防止不良事件的发生。Objective To analyse the effectiveness and safety of rivaroxaban at dosage of 10 mg/d and 15 mg/d in elderly patients with nonvalvular atrial fibrillation(NVAF),and investigate the factors that may contribute to the incidence of both efficacy and safety?related events.Methods A total of 259 NVAF patients aged 75 years and older who were admitted to the First Affiliated Hospital of Xi′an Jiaotong University from January 2019 to December 2021 were selected.According to the dose of rivaroxaban at the time of discharge,the patients were divided into two groups:the 10 mg group(n=167)and the 15 mg group(n=92).The patients were followed up for 1 year,and death,ischemic stroke and bleeding events were recorded.Factors influencing the rivaroxaban dosage selection and the occurrence of outcome events were analyzed.Results Mortality,the rate of ischemic stroke events,and bleeding events in the 2 groups were compared,and the difference was not statistically significant(all P>0.05).Regression analysis found that 10 mg/d rivaroxaban was more recommended with increasing age(OR=0.866,95%CI:0.807?0.929,P<0.001).Additionally,patients with heart failure(OR=3.783,95%CI:1.355?10.561,P<0.05),myocardial infarction(OR=5.287,95%CI:1.692?16.525,P<0.01)were more likely to experience death or ischemic stroke events.Patients with neoplasms(OR=6.389,95%CI:1.772?23.029,P<0.01)were more likely to have bleeding events.Conclusion 10 mg/d has the same safety and efficacy as 15 mg/d rivaroxaban.Preventive management of NVAF patients associated with heart failure,myocardial infarction,and neoplasms should be strengthened to prevent adverse events.

关 键 词：心房颤动 老年 利伐沙班 

分 类 号：R54[医药卫生—心血管疾病]