利伐沙班在高龄老年非瓣膜性房颤患者抗凝治疗的疗效及安全性

摘要

目的 观察长期应用利伐沙班治疗高龄老年非瓣膜性房颤(NVAF)患者的疗效及安全性.方法 入选2014年1月~2016年6月期间于陆军总医院干部病房住院和门诊就诊的NVAF患者75例,男性53例,女性22例.依据年龄分为高龄老年组(38例,>80岁)和老年组(37例,65岁~80岁).两组患者根据HAS-BLED评分高低确定初始口服利伐沙班剂量,然后根据患者具体病情调整剂量.治疗前和治疗中检测凝血功能相关指标,包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)及血小板计数(PLT).随访1年,比较两组临床栓塞事件、药物不良反应(出血、皮疹、便潜血阳性等).结果 连续监测1年,高龄老年组和老年组利伐沙班的用药剂量均为5~15 mg/d,平均应用剂量分别为(10.00±2.50)mg/d和(10.13±2.63)mg/d,差异比较无统计学意义(P>0.05).与服药前比较,高龄老年组服用利伐沙班治疗1个月、6个月、12个月后PT、APTT、TT均升高,FIB与D-D降低,差异有统计学意义(P均<0.05);老年组治疗1个月、6个月、12个月后PT、APTT、TT均升高,FIB和D-D降低,差异有统计学意义(P均<0.05).所有患者均无再发急性脑梗死,均无严重出血,出现轻微出血经调整用药剂量后症状消失.结论 高龄老年NVAF患者应用适当利伐沙班(5~15 mg/d)抗凝治疗安全有效.%Objective To study the efficacy and safety of long-term use of rivaroxaban in the treatment of elderly patients with nonvalvular atrial fibrillation (NVAF). Methods The NVAF patients were divided into two groups, including oldest-old group (n=38, ≥80 years old, average age=85.20±3.05) and old group (n=37, 65-79 years old, average age=76.5±2.07). The initial oral dose of rivaroxaban was determined according to the HAS-BLED score, and the dose was adjusted according to condition of patients. Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (D-D), platelet count (PLT) were measured before and during the treatment. The clinical embolism events and adverse drug reactions (bleeding, rash, fecal occult blood positive, etc.) during one-year follow-up were compared between two groups. Results The average dose of rivaroxaban in oldest-old group and old group was (10.00±2.50) mg/d and (10.13±2.63) mg/d respectively (range from 5 to 15 mg/d), the difference was not statistically significant (P>0.05). After treatment for 1 month, 6 months and 12 months, the levels of PT, APTT and TT were increased, the levels of FIB and D-D were deceased in oldest-old group, the differences were statistically significant (all P<0.05). After treatment for 1 month, 6 months and 12 months, the levels of PT, APTT and TT were increased, the levels of FIB and D-D were deceased in old group, the differences were statistically significant (all P<0.05). No recurrence of acute cerebral infarction, no severe bleeding was recorded. Mild bleeding was disappeared after adjusting dose. Conclutions Rivaroxaban (5-15 mg / d) is effective and safe for elderly NVAF patients.