达比加群酯对患者凝血功能的影响及相关影响因素分析

Analysis of the effect of dapigatron etexilate on coagulation function and related influencing factors in patients

目的:调查患者使用达比加群酯治疗后凝血状况的变化,以及肝肾功能变化对凝血指标和出血情况的影响,为临床更好地使用达比加群酯提供参考依据。方法:收集中日友好医院2017年4月1日至2018年3月31日住院期间使用达比加群的患者信息,进行回顾性分析。通过分析患者的凝血指标、肝肾情况、出血情况,分析达比加群酯对这些指标的影响。结果:共收集患者247例,男性139例(56.28%),女性108例(43.72%),平均(72.11±29.26)岁。共有189例患者测定了便潜血,其中免疫法检测阳性或弱阳性患者32例(16.93%),化学法检测阳性或弱阳性患者30例(15.87%)。共有220例患者测定了尿红细胞(高倍镜),其中阳性患者30例(13.64%)。患者服用达比加群前后TT、APTT值变化十分明显。肾功能对APTT的影响无显著性差异。CrCL>50 mL·min^-1的患者免疫法、化学法便潜血阳性的患者比例分别为16.77%,15.48%,尿红细胞阳性患者比例为1.08%;30≤CrCL≤50 mL·min^-1的患者免疫法、化学法便潜血阳性的患者比例均为25.00%,尿红细胞阳性患者比例为9.52%;CrCL<30 mL·min^-1的患者免疫法、化学法便潜血阳性的患者比例均为22.00%,尿红细胞阳性患者比例为25.00%。肾功能损伤的患者出血风险增加,应注意应密切监测。ALT或AST一项或两项均升高组的患者服用达比加群后,免疫法、化学法便潜血阳性的患者比例均为29.17%,尿红细胞阳性患者比例为26.93%。相比于正常组患者分别升高了2倍和2.03倍,而尿红细胞阳性患者比例升高了2.22倍。结论:高龄、有出血史等高危患者使用达比加群时注意凝血功能监测,当APTT升高2倍以上时,注意是否有隐匿性出血。肾功能对APTT无明显影响,肝酶异常时APTT延长。肝肾异常患者使用达比加群时出血风险增大,注意监测。

OBJECTIVE To investigate the changes of coagulation status after treatment with dabigatran etexilate, and the effect of liver and kidney function changes on coagulation parameters and bleeding, so as to provide reference for clinical use of dabigatran etexilate. METHODS The information of patients who used dabigatran during hospitalization from April 1, 2017 to March 31, 2018 in China-Japan Friendship Hospital was collected for retrospective analysis.The effects of dabigatran etexilate on coagulation parameters, liver and kidney conditions and bleeding were analyzed. RESULTS A total of 247 patients were enrolled, 139(56.28%) males and 108(43.72%)females. The average age of the patients was(72.11±29.26) years old.A total of 189 patients were tested for fecal occult blood. Among them, 32 patients(16.93%) were positive or weakly positive by immunoassay, and 30(15.87%) were positive or weakly positive by chemical method.A total of 220 patients were tested for urinary red blood cells(high power), of which 30(13.64%) were positive.The changes of TT and APTT values before and after administration of dabigatran were very significant.There was no significant difference in the effect of renal function on APTT.The proportion of patients with CrCL>50 mL·min-1 who were positive for immunotherapy and chemical occult blood was 16.77% and 15.48%, respectively.The proportion of patients with urinary red blood cells positive is 1.08%.The proportion of patients with 30≤CrCL≤50 mL·min^-1 immunological method and chemical method for occult blood positive was 25.00%.The proportion of patients with urinary red blood cells is 9.52%.The proportion of patients with CrCL<30 mL·min^-1 immunological and chemical occult blood positive was 22.00%.The proportion of patients with urinary red blood cells is 25.00%. Patients with impaired renal function have an increased risk of bleeding and should be closely monitored. After taking dabigatran in patients with elevated ALT or AST, the proportion of patients with positive immunotherapy and chemical occult blood was 29.17%.The proportion of patients with urinary red blood cells is 26.93%.Compared with the normal group, the positive rate of occult blood increased by 2 times and 2.03 times compared with the immunological and chemical methods, respectively, while the proportion of urinary red blood cells positive patients increased by 2.22 times. CONCLUSION The coagulation function should be monitored when dabigatran is used in elderly patients with high risk of bleeding history. When APTT increases by more than 2 times, attention should be paid to whether there is occult bleeding.Renal function had no significant effect on APTT, and APTT was prolonged when liver enzymes were abnormal.Patients with hepatic or renal abnormalities may be at increased risk of bleeding with dabigatran and should be monitored.