利伐沙班与华法林治疗左心室心尖部血栓的疗效比较

Comparative Study of Rivaroxaban and Warfarin for Treating the Patients With Left Ventricular Thrombus

目的：比较利伐沙班与华法林治疗左心室心尖部血栓的疗效及安全性。方法：31例左心室心尖部血栓患者随机分为两组，华法林组（n=16例）患者初始治疗与低分子肝素合用，剂量2.5~3 mg，至国际标准化比值（INR）达2.0~3.0停用低分子肝素，继续维持华法林治疗，3天监测1次INR，共3次， INR稳定在2.0~3.0，以后每2周监测1次INR；利伐沙班组（n=15例）患者口服利伐沙班片剂10 mg，2次/d。随访时间3个月，比较两组患者血栓消失时间、治疗期间新发血栓栓塞事件以及出血事件。结果：两组患者在年龄、性别、合并疾病、血栓大小及药物治疗等方面差异均无统计学意义。与华法林组比较，利伐沙班组的血栓消失时间缩短[（60.00±5.50）d vs （71.00±8.50）d，P〈0.01]；两组的新发血栓栓塞事件（脑栓塞、体循环栓塞）差异无统计学意义（P〉0.05），华法林组出血事件多于利伐沙班组，但差异也无统计学意义（P〉0.05）。结论：治疗左心室心尖部血栓利伐沙班较华法林起效更快，不增加出血风险。

Objective： To compare the safety and efifcacy of rivaroxaban and warfarin for treating the patients with left ventricular thrombus. Methods： A total of 31 patients with left ventricular thrombus were studied, the patients were randomly divided into 2 groups：Warfarin group, n=16, the patients initially received oral warfarin and low molecular weight heparin at （2.5-3） mg/day, when the INR value reached 2.0-3.0, heparin was stopped and warfarin was continued, the INR value was monitored every 3 days for 3 times, when INR value was stably kept at 2.0-3.0, it was then monitored for every 2 weeks. Rivaroxaban group,n=15, the patients received oral rivaroxaban at 10 mg twice a day. All patients were followed-up for 3 months, the thrombus remission time, new onset of thrombosis, embolism and bleeding events during treatment period were compared between 2 groups. Results： The patients’ age, gender, complication, size of thrombus and medication were similar between 2 groups. Compared with Warfarin group, Rivaroxaban group had the shorter thrombus remission time, （60.00±5.50）d vs （71.00±8.50） d,P〈0.01, while the new onset of thrombosis and embolism events as cerebral embolism and systemic embolism were similar between 2 groups, Warfarin group had slightly higher bleeding events, allP〉0.05. Conclusion： Rivaroxaban had better effect than warfarin for treating the patients with left ventricular thrombus without increasing the risk of bleeding.