利伐沙班和阿司匹林联用在老年非瓣膜性心房纤颤患者中的抗凝效果

Anticoagulant Effect of Rivaroxaban and Aspirin in ElderlyPatients with Non-valvular Atrial Fibrillation

目的:探讨小剂量利伐沙班和阿司匹林对老年非瓣膜性心房纤颤患者血小板及微粒(MPs)促凝活性的影响。方法:将120例老年非瓣膜性心房纤颤患者随机分为研究组和对照组(n=60)。研究组采用小剂量利伐沙班联合阿司匹林进行抗凝治疗,对照组采用华法林进行抗凝治疗,均连续治疗、观察6个月。检测比较两组凝血功能指标、血小板及MPs促凝活性指标变化,比较两组再次入院、栓塞、出血及死亡等临床不良事件发生率以及不良反应发生率。结果:与对照组比较,研究组治疗6个月的血小板计数、磷脂酰丝氨酸(PS)阳性(PS^+)血小板、总MPs及血小板释放的微粒(PMPs)水平降低,同期凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板及MPs促凝血时间延长,不良事件发生率降低(P<0.05)。与治疗前比较,两组治疗6个月后的血小板计数、PS^+血小板、总MPs及PMPs水平降低,同期PT、APTT、血小板及MPs促凝血时间延长(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:小剂量利伐沙班和阿司匹林在老年非瓣膜性心房纤颤患者抗凝效果良好,可有效降低血小板及微粒促凝活性,值得推广应用。

Objective:To investigate the effect of low-dose rivaroxaban and aspirin on platelet and microparticles(MPs)procoagulatory activity in elderly patients with nonvalvular atrial fibrillation.Methods:120 elderly patients with non-valvular atrial fibrillation were randomly divided into study group and control group(n=60).The study group was treated with low dose of rivaroxaban and aspirin.The control group was treated with warfarin.The patients in both groups were treated and observed for 6 months.The changes of coagulation function,platelet and MPs activity were detected and compared between the two groups.The adverse clinical events such as readmission,embolism,bleeding and death and the rate of adverse reactions in the two groups were compared.Results:Compared with the control group,the platelet count,phosphatidylserine(PS)-positive platelet,total MPs and platelet releasing microparticles(PMPs)in the study group decreased,meanwhile prothrombin time(PT),activated partial thromboplastin time(APTT),platelet and MPs procoagulant time in the study group prolonged,and the rate of adverse clinical events in the study group decreased(P<0.05).Compared with that of before treatment,levels of platelet count,PS^+platelet,total MPs and PMPs in the two groups decreased after 6 months of treatment,meanwhile PT,APTT,platelet and MPs procoagulant time in the two groups prolonged after treatment(P<0.05).There was no significant difference in the adverse reactions rate between the two groups(P>0.05).Conclusion:Low dose rivaroxaban and aspirin have good anticoagulant effect in the elderly patients with non-valvular atrial fibrillation,can effectively reduce platelet and microparticle procoagulant activity.Therefore,this new drug combination worth to be clinically promoted.