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徐燕, 梁佳佳, 朱凯媛, 等. 小剂量利伐沙班对高龄非瓣膜性心房颤动患者的抗凝效果及安全性评价[J]. 中国临床医学, 2023, 30(5): 825-830. DOI: 10.12025/j.issn.1008-6358.2023.20230616
引用本文: 徐燕, 梁佳佳, 朱凯媛, 等. 小剂量利伐沙班对高龄非瓣膜性心房颤动患者的抗凝效果及安全性评价[J]. 中国临床医学, 2023, 30(5): 825-830. DOI: 10.12025/j.issn.1008-6358.2023.20230616
XU Yan, LIANG Jia-jia, ZHU Kai-yuan, et al. Anticoagulant effect and safety evaluation of low-dose rivaroxaban in elderly patients with non-valvular atrial fibrillation[J]. Chinese Journal of Clinical Medicine, 2023, 30(5): 825-830. DOI: 10.12025/j.issn.1008-6358.2023.20230616
Citation: XU Yan, LIANG Jia-jia, ZHU Kai-yuan, et al. Anticoagulant effect and safety evaluation of low-dose rivaroxaban in elderly patients with non-valvular atrial fibrillation[J]. Chinese Journal of Clinical Medicine, 2023, 30(5): 825-830. DOI: 10.12025/j.issn.1008-6358.2023.20230616

小剂量利伐沙班对高龄非瓣膜性心房颤动患者的抗凝效果及安全性评价

Anticoagulant effect and safety evaluation of low-dose rivaroxaban in elderly patients with non-valvular atrial fibrillation

  • 摘要:
    目的 探讨小剂量利伐沙班对高龄非瓣膜性心房颤动(NVAF)患者的抗凝效果及安全性。
    方法 选择2018年1月至2020年1月启东市人民医院收治的口服华法林或利伐沙班的450例高龄(年龄≥80岁)NVAF患者,根据服药情况分为华法林组(n=156)、利伐沙班15 mg组(n=143)和利伐沙班10 mg组(n=151)。3组均治疗12个月,比较3组患者治疗前后凝血功能指标水平,栓塞、出血及药物相关不良反应发生率。
    结果 治疗前,3组高龄NVAF患者的血浆凝血酶原时间(PT)、国际标准化比值(INR)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)差异无统计学意义。治疗后2个月,3组高龄NVAF患者的PT、INR、TT、APTT均较治疗前延长(P<0.05);两利伐沙班组较华法林组延长更明显(P<0.05);除TT外,其余凝血指标在利伐沙班15 mg组较利伐沙班10 mg组延长更明显(P<0.05)。华法林组、利伐沙班15 mg组、利伐沙班10 mg组栓塞事件总发生率分别为4.49%、4.20%、5.30%,差异无统计学意义;3组出血事件总发生率分别为11.54%、5.59%、3.97%,药物相关不良反应总发生率分别为19.23%、10.49%、8.61%,利伐沙班10 mg组出血事件、药物相关不良反应总发生率均显著低于华法林组(P<0.05),利伐沙班15 mg组与华法林组以及两利伐沙班组间差异无统计学意义。
    结论 小剂量(10 mg)利伐沙班对高龄NVAF患者的抗凝效果及安全性优于华法林,预防栓塞的效果及安全性不劣于常规剂量(15 mg)利伐沙班。

     

    Abstract:
    Objective To explore the anticoagulation efficacy and safety of low-dose rivaroxaban in elderly patients with non-valvular atrial fibrillation (NVAF).
    Methods 450 patients aged ≥80 years old with NVAF who took oral warfarin or rivaroxaban in Qidong People's Hospital from January 2018 to January 2020 were selected. They were divided into warfarin group (group A, n=156), rivaroxaban 15 mg group (group B, n=143), and rivaroxaban 10 mg group (group C, n=151). The patients in the three groups treated 12 months, and the coagulation function before and after treatment, and rates of embolism, bleeding and adverse reactions were compared among the three groups.
    Results Before treatment, there was no significant difference in plasma prothrombin time (PT), international normalized ratio (INR), thrombin time (TT) and activated partial thromboplastin time (APTT) among the three groups. Two months after treatment, PT, INR, TT and APTT of the elderly NVAF patients in the three groups were prolonged (P < 0.05), and were prolonged more in group B and group C (P < 0.05), PT, INR and APTT of patients prolonged more in group B than those in group C (P < 0.05). The total incidence of embolism events in group A, group B, and group C were 4.49%, 4.20%, and 5.30%, respectively, with no statistically significant difference. The total incidences of bleeding events and adverse reactions in group A, group B, and group C were 11.54%, 5.59%, 3.97%, and 19.23%, 10.49%, and 8.61%, respectively. The total incidences of bleeding events and adverse reactions in group C were significantly lower than those in group A (P < 0.05), and there was no statistically significant difference between group B and group A, and between group B and group C.
    Conclusion In elderly NVAF patients aged ≥80 years, the low-dose (10 mg) rivaroxaban has better anticoagulation efficacy and safety compared to warfarin, and the effect of preventing embolism and safety are not worse than that of conventional dose (15 mg) rivaroxaban.

     

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