利伐沙班和达比加群酯及华法林在非瓣膜性心房颤动患者抗凝治疗的研究

Rivaroxban,dabigatran etexilate and warfarin in anticoagulant treatment of nonvalvular atrial fibrillation patients

目的比较新型抗凝药物利伐沙班和达比加群酯与传统抗凝药物华法林在非瓣膜性心房颤动(房颤)患者缺血性脑卒中预防的有效性和安全性。方法选择我院门诊及病房治疗的非瓣膜性房颤患者160例,患者均未服抗凝药,根据患者服药意愿分别纳入利伐沙班组80例(拜瑞妥,20mg,1次/d)和达比加群酯组80例(泰毕全,110mg,2次/d),选择本院同期服用华法林的房颤患者80例为华法林组,所有患者服药≥3个月,3组在年龄、性别、房颤血栓危险度评分及房颤射频消融术方面相匹配。随访3个月,比较3组患者缺血性脑卒中、非中枢神经系统性栓塞事件、出血事件及不良反应的发生率。结果利伐沙班组和达比加群酯组栓塞事件发生率均低于华法林组(11.3%和13.8%vs 28.8%,P=0.008),利伐他班组和达比加群酯组出血事件发生率亦较华法林组低(10.0%和7.5%vs 21.3%,P=0.022)。华法林组皮疹发生率较利伐沙班组和达比加群组高(11.3%vs 0%和2.5%,P=0.002)。结论新型口服抗凝药物利伐沙班和达比加群酯对非瓣膜性房颤患者缺血性脑卒中预防效果优于或等同于华法林,安全性亦较好,值得临床推广应用。

Objective To compare the efficiency and safety of rivaroxaban,dabigatran etexilate and warfarin for prevention of ischemic stroke in nonvalvular atrial fibrillation（AF）patients.Methods Two hundred and forty nonvalvular AF patients admitted to our hospital were divided into rivaroxaban treatment group（n=80）,dabigatran etexilate treatment group（n=80）and warfarin treatment group（n=80）.The patients were followed up for 3 months,during which bleeding events and adverse reaction were compared after the patients were treated with rivaroxaban,dabigatran etexilate and warfarin respectively for≥3 months.Results The incidence of thrombotic events and bleeding events was significantly lower in rivaroxaban treatment group and dabigatran etexilate treatment group than in warfarin treatment group（11.3% vs 28.8%,13.8%,P=0.008;10.0%vs 21.3%,7.5%,P=0.022）.The incidence of rash was significantly higher in warfarin treatment group than in rivaroxaban treatment group and dabigatran etexilate treatment group（11.3% vs 0%,2.5%,P=0.002）.Conclusion The efficiency and safety of rivaroxaban and dabigatran etexilate are better than those of warfarin for prevention of ischemic stroke in nonvalvular AF patientss,and are thus worthy of popularization in clinical practice.