摘要
目的探讨新型口服抗凝药利伐沙班、达比加群酯与传统抗凝药华法林治疗高龄非瓣膜性心房颤动患者缺血性脑卒中的有效性和安全性。方法回顾性分析自2012年5月至2016年10月沈阳军区总医院干部病房收治的75岁以上非瓣膜性心房颤动患者152例的临床资料。根据用药情况,将患者分为华法林组(A组,n=50)、达比加群酯组(B组,n=55)及利伐沙班组(C组,n=47)。所有患者服药时间≥1年,随访1年,比较3组患者的缺血性脑卒中事件发生率、出血事件发生率、病死率及用药前后相关凝血指标变化情况。结果 3组患者的缺血性脑卒中事件发生率、非严重临床相关出血发生率及病死率比较,差异均无统计学意义(P>0.05);B组轻微出血事件发生率与A组比较,差异有统计学意义(P<0.05)。A组用药后国际标准化比率(INR)控制在1.6~2.5,说明患者在医师严密监控下INR达标率较高;B组患者用药后的部分凝血活酶时间及C组患者的凝血酶原时间较治疗前均明显延长,但均未超过正常值2倍(P<0.05),而用药后1个月与1年比较,差异无统计学意义(P>0.05)。结论达比加群酯可安全地应用于肌酐清除率(Ccr)≥30 ml/min、合并多种疾病的高龄非瓣膜性心房颤动患者。而对于Ccr为15~30 ml/min的高龄非瓣膜性心房颤动患者,选择低剂量的利伐沙班(10 mg/d)更合适,其抗凝效果不劣于传统抗凝药物华法林,大出血风险低于华法林,并且无需频繁抽血监测凝血功能,其优势更加明显。
Objective To investigate the effectiveness and safety of the new oral anticoagulants,Rivaroxaban,Dabigatran and traditional anticoagulants Warfarin in the prevention of the ischemic cerebral patients at advanced age with non-valvular atrial fibrillation.Methods A retrospective study was performed on 152 cases of patients with non-valvular atrial fibrillation who were over 75 years old and were admitted from May 2012 to October 2016. According to the medication,patients were divided into the Warfarin group（ Group A,n = 50）,Dabigatran group（ Group B,n = 55） and Rivaroxaban group（ Group C,n = 47）. All patients were treated for 1 year and followed up for 1 year. The ischemic cerebral stroke events,bleeding events,mortality and medication related coagulation index were compared among the three groups. Results There was no statistically significant difference among the three groups of ischemic cerebral stroke events,the incidence of non-severe clinical bleeding and mortality（ P〉0. 05）; the incidence of minor bleeding events in Group B was statistically significant different from that in Group A（ P〈0. 05）. The international standardized ratio（ INR） of Group A was controlled at 1. 6-2. 5,indicating that the patients had a higher INR target rate under the close supervision of the physician. The thromboplastin time of the patients in Group B and the thrombin time in Group C were significantly longer than those before treatment,while they were not more than 2 times of normal value（ P〈0. 05）. There was no statistically significant difference between 1 month and 1 year after administration（ P〉0. 05）. Conclusion For the non-valvular atrial fibrillation patients at advanced age,who was non-nasal feeding,and with Ccr≥30 ml/minutes,Dabigatran has a better effect in prevention of the ischemic stroke. For high-risk patients with Ccr was 15-30 ml/minutes,low dose Rivaroxaban is a better choice,its anticoagulant effect is not inferior to Warfarin,with lower risk of large hemorrhage,and it does not need frequent blood sampling to monitor the coagulation function,which is a significant advantage.
作者
梁春波
马瑾华
刘岩
李红帅
刘艳霞
LIANG Chun-bo;MA Jin-hua;LIU Yan;LI Hong-shuai;LIU Yan-xia(Second Cadre Ward,The General Hospital of Shenyang Military Command, Shenyang 110016, China)
出处
《临床军医杂志》
CAS
2018年第5期548-551,共4页
Clinical Journal of Medical Officers
作者简介
梁春波（1977-），女，辽宁辽中人，主治医师，硕士;通信作者：刘艳霞，E-mail：Lyxzp7092@sina．com
