利伐沙班与阿哌沙班治疗房颤并发急性缺血性脑卒中的有效性和经济性

Efficacy and economy of rivaroxaban and apixaban in treatment of atrial fibrillation complicated with acute ischemic stroke

目的比较利伐沙班与阿哌沙班治疗房颤并发急性缺血性脑卒中的有效性及成本-效果。方法选取2021年1月至2022年1月收治的100例房颤并发急性缺血性脑卒中患者,按照随机数字表法分为阿哌沙班组与利伐沙班组,每组50例,分别采用利伐沙班治疗和阿哌沙班治疗。评估2组临床疗效及不良反应和比较2组治疗前后神经功能、日常生活能力及血液流变指数。采用成本-效果法分析2种抗凝方案治疗房颤并发急性缺血性卒中的药物经济学,并进行敏感性分析。结果阿哌沙班组临床总有效率略低于利伐沙班组,但组间差异无统计学意义(91.84%vs 95.83%,P>0.05)。2组患者治疗后美国国立卫生研究院卒中量表(NIHSS)评分、全血黏度、红细胞沉降率、血浆黏度等显著低于治疗前(P<0.05),2组治疗后Barthel指数评分显著高于治疗前(P<0.05),阿哌沙班组患者NIHSS评分、Barthel指数评分、全血黏度、红细胞沉降率、血浆黏度与利伐沙班组比较差异均无统计学意义(P>0.05)。阿哌沙班组患者不良反应发生率明显低于利伐沙班组(P<0.05)。阿哌沙班组治疗总成本明显低于利伐沙班组(P<0.05)。通过质量调整寿命年(QALY)、成本差值计算增量成本收益比以及敏感性分析,发现阿哌沙班组药物经济性优于利伐沙班组(P<0.05)。结论阿哌沙班治疗房颤并发急性缺血性脑卒中临床疗效与利伐沙班相近,两者均能改善血液流变学,提高日常生活质量,减轻神经功能缺损,但阿哌沙班出血风险更低且药物经济学更佳。

AIM To compare the efficacy and cost-effectiveness of rivaroxaban and apixaban in the treatment of atrial fibrillation complicated with acute ischemic stroke.METHODS A total of 100 patients with atrial fibrillation complicated with acute ischemic stroke from January 2021 to January 2022 were randomly divided into apixaban group and rivaroxaban group according to the random number table method,with 50 patients in each group.The rivaroxaban group was treated with rivaroxaban,and the apixaban group was treated with apixaban.The clinical efficacy and adverse reactions of 2 groups were evaluated.The neurological function,activities of daily living,and hemorheological index were compared between 2 groups before and after treatment.The cost-effectiveness method was used to analyze the pharmacoeconomics and sensitivity of two anticoagulant regimens in the treatment of atrial fibrillation complicated with acute ischemic stroke.RESULTS The total clinical effective rate of apixaban was slightly lower than that of rivaroxaban,but the difference was not statistically significant(91.84%vs 95.83%,P>0.05).After treatment,the scores of national institutes of health stroke scale(NIHSS),whole blood viscosity,erythrocyte sedimentation rate and plasma viscosity of 2 groups were significantly lower than those before treatment(P<0.05),and the Barthel index scores of 2 groups after treatment were significantly higher than those before treatment(P<0.05).There were no significant differences in NIHSS score,Barthel index score,whole blood viscosity,erythrocyte sedimentation rate,and plasma viscosity between apixaban and rivaroxaban(P>0.05).The incidence of adverse reactions in apixaban group was significantly lower than that in rivaroxaban group(P<0.05).The total treatment cost of apixaban group was significantly lower than that of rivaroxaban group(P<0.05).By calculating the incremental cost-benefit ratio and sensitivity analysis through quality-adjusted life years(QALY)and cost difference,it was found that the drug economy of apixaban was better than that of rivaroxaban(P<0.05).CONCLUSION Apixaban has similar clinical efficacy to rivaroxaban in the treatment of atrial fibrillation complicated with acute ischemic stroke.Both of them can improve hemorheology,improve quality of daily life,and reduce neurological deficit.However,apixaban may have lower bleeding risk and better pharmacoeconomics.