低剂量利伐沙班在高龄老年非瓣膜性心房颤动患者中的抗凝疗效观察  

Observation of anticoagulant effect of low dose rivaroxaban in senile patients with non-valvular atrial fibrillation

作　　者：侯鹏 柳建红 周兆欣 赵晨妍 詹秀娥 李春兰 Hou Peng;Liu Jianhong;Zhou Zhaoxin;Zhao Chenyan;Zhan Xiue;Li Chunlan(Department of Cardiology,the Third Peoples Hospital of Gansu Province,Lanzhou 730020,China;Department of Endocrinology,the Third People’s Hospital of Gansu Province,Lanzhou 730020,China)

机构地区：[1]甘肃省第三人民医院心内科,兰州730020 [2]甘肃省第三人民医院内分泌科,兰州730020

出　　处：《中国心血管杂志》2024年第4期325-331,共7页Chinese Journal of Cardiovascular Medicine

基　　金：甘肃省自然科学基金(22JR5RA731);陇原青年创新创业人才(团队)项目(2018)。

摘　　要：目的观察低剂量利伐沙班在高龄老年非瓣膜性心房颤动(房颤)患者中抗凝的有效性和安全性。方法回顾性研究。纳入2019年4月至2023年3月在甘肃省第三人民医院住院的321例老年(年龄≥65岁)非瓣膜性房颤患者,分为两组:房颤出血风险评估(HAS-BLED)评分≤2分且年龄65~80岁者为对照组(123例),给予利伐沙班15 mg/d口服;HAS-BLED评分≥3分且年龄≥80岁者为观察组(198例),给予利伐沙班10 mg/d口服。平均随访1年,收集患者的血常规、尿便常规、凝血功能、肝肾功能和头颅磁共振成像检查结果,比较抗凝治疗后两组患者血栓栓塞事件发生率(包括新发缺血性脑卒中和外周血栓栓塞)和出血事件发生率(脑出血等);比较治疗前后两组患者肝肾功能、血小板计数和凝血功能。结果治疗后,观察组和对照组分别出现9例和5例脑梗死、3例和2例下肢静脉栓塞,均未发生肺栓塞;两组血栓栓塞事件发生率比较,差异无统计学意义(6.1%比5.7%,χ^(2)=0.896,P=0.344)。治疗后,观察组和对照组分别出现3例和2例便潜血阳性、6例和4例皮肤黏膜出血,均未发生脑出血、咯血、血尿和呕血;两组出血事件发生率比较,差异无统计学意义(4.5%比4.9%,χ^(2)=0.019,P=0.891)。治疗前后两组患者的血小板计数、凝血功能和肝肾功能均未见明显异常(均为P>0.05)。结论低剂量(10 mg/d)利伐沙班可有效预防高龄(年龄≥80岁)老年非瓣膜性房颤患者发生脑卒中,而且不增加出血风险和肝肾功能损害。Objective To observe the efficacy and safety of low dose rivaroxaban in advanced age patients with non-valvular atrial fibrillation(NVAF).Methods Retrospectively analyzed 321 elderly patients(aged≥65 years)with NVAF hospitalized in the Third People’s Hospital of Gansu Province from April 2019 to March 2023.The patients were divided into control group(65-79 years old,HAS-BLED score≤2,n=123),Rivaroxaban 15 mg orally once a day,and observation group(80 years old or over,HAS-BLED score≥3,n=198),Rivaroxaban 10 mg orally once a day.Thromboembolic events and bleeding events were collected and compared between the two groups after 1 year follow-up.Results There were 9 patients in observation group and 5 patients in control group suffered from cerebral infarction,and 3 patients in observation group and 2 patients in control group had venous embolism,respectively.No pulmonary embolism occurred.There was no significant difference in the incidence of thromboembolic events between the two groups(6.1%vs.5.7%,χ^(2)=0.896,P=0.344).There were 3 patients in observation group and 2 in control group had positive stool occult blood,6 patients in observation group and 4 in control group had skin or mucous membrane minor hemorrhage,respectively.No cerebral hemorrhage,hemoptysis,hematuria and hematemesis occurred.There was no significant difference in the incidence of bleeding events between the two groups(4.5%vs.4.9%,χ^(2)=0.019,P=0.891).There were no significant abnormalities in platelet count,coagulation function,liver and kidney function in 2 groups before and after treatment(all P>0.05).Conclusions A low dose of 10 mg daily of rivaroxaban can effectively prevent ischemic stroke in senile patients(≥80 years)with non-valvular atrial fibrillation without increasing the risk of bleeding.

关 键 词：高龄老人 非瓣膜性心房颤动 利伐沙班 脑卒中 

分 类 号：R541.75[医药卫生—心血管疾病]