新型口服抗凝药物治疗高龄非瓣膜性房颤患者的疗效分析

Analysis on effect of new oral anticoagulants in treatment of elderly patients with non-valvular atrial fibrillation

目的比较新型口服抗凝药物（NOAC）利伐沙班、达比加群酯和传统抗凝药物华法林用于高龄非瓣膜性房颤患者抗凝治疗的有效性和安全性。方法将264例高龄非瓣膜性房颤患者分为3组,利伐沙班组88例,达比加群酯组88例;华法林组88例,根据国际标准化比值（INR）调整剂量,将INR控制在2.00-2.50。结果卒中或血栓栓塞事件在利伐沙班组发生2例（2.27%）;达比加群酯组发生3例（3.41%）;华法林组发生4例（4.55%）。出血事件在利伐沙班组发生7例（7.95%）;达比加群酯组发生6例（6.82%）;华法林组发生13例（14.77%）。3组间卒中或血栓栓塞的发生率比较差异无统计学意义（P〉0.05）;利伐沙班组和达比加群酯组出血事件的发生率低于华法林组（P〈0.05）,但利伐沙班组与达比加群酯组比较差异无统计学意义（P〉0.05）。结论 NOAC利伐沙班、达比加群酯与华法林比较,在降低高龄非瓣膜性房颤患者卒中和血栓栓塞事件方面,治疗效果与华法林相当,而出血事件的发生率低于华法林。

Objective To compare the efficacy and safety between new oral anticoagulant（NOAC）rivaroxaban and dabigatran etexilate with warfarin in the treatment of elderly patients with non-valvular atrial fibrillation（NVAF）.Methods Totally 264 cases of NVAF were divided into three groups：rivaroxaban group,dabigatran etexilate group and warfarin group,88 cases in each group.The dose of warfarin in the warfarin group was adjusted according to the international normalized ratio（INR）,INR was controlled at 2.00-2.50.Results Two cases（2.27%）of stoke or thromboembolic events occurred in the rivaroxaban group,3cases（3.41%）occurred in the dabigatran etexilate group and 4cases（4.55%）occurred in the warfarin group.Seven cases（7.95%）of bleeding events occurred in the rivaroxaban group,6cases（6.82%）occurred in the dabigatran etexilate group and 13cases（14.77%）occurred in the warfarin group.The incidence rates of stoke and thromboembolic events had no statistical difference among the three groups（P〈0.05）;the incidence rate of bleeding events in the rivaroxaban and the dabigatran etexilate groups were lower than that in the warfarin group（P〈0.05）,but which no statistical difference between the rivaroxaban and the dabigatran etexilate group（P〈0.05）.Conclusion NOAC rivaroxaban and dabigatran etexilate have the similar curative effect as warfarin for reducing the incidence of stroke and thromboembolic events in elderly patients with NVAF,while the incidence rate of bleeding events is lower than that of warfarin.