非瓣膜性房颤患者应用利伐沙班出血危险因素分析

Risk Factors for Rivaroxaban-related Hemorrhage in Patients with Non-valvular Atrial Fibrillation

目的:分析非瓣膜性房颤患者服用利伐沙班发生出血的危险因素。方法:收集2017年3~6月201例使用利伐沙班抗凝治疗的拟行射频消融术的非瓣膜性住院患者资料,记录患者年龄、性别、既往史,以及C反应蛋白、血糖、肝肾功能、心功能指标、合并疾病及联合用药等信息。采用单因素方差分析和多因素回归分析方法评估相关出血危险因素。结果:在所有纳入研究的患者中住院期间共有23例(11.4%)发生了出血,178例(88.6%)未发生出血,利伐沙班引起的出血发生率为11.4%(23/201)。研究发现合并冠心病与利伐沙班引起的出血事件有显著的相关性[P=0.001,OR=4.013,95%CI(1.634,9.859)],此外,联合应用阿司匹林[P=0.001,OR=5.111,95%CI(1.961,13.319)]或氯吡格雷[P=0.001,OR=5.490,95%CI(2.150,14.017)],其出血风险会显著增加。合用氯吡格雷[P=0.029,OR=3.281,95%CI(1.129,9.531)]和凝血酶原时间(PT)>13.0 s[P=0.034,OR=2.914,95%CI(1.082,7.851)]可显著增加利伐沙班相关的出血风险。结论:合并冠心病和联用抗血小板药物(阿司匹林、氯吡格雷)与利伐沙班引起的出血事件有显著的相关性。多因素回归分析发现,联用氯吡格雷和PT>13.0 s是非瓣膜性房颤患者应用利伐沙班发生出血的独立危险因素。

Objective:To identify clinical risk factors associated with hemorrahge among patients with nonvalvular atrial fibrillation who initiated rivaroxaban therapy.Methods:201 inpatients with non-valvular inpatients undergoing radiofrequency ablation with rivaroxaban anticoagulant therapy from March 2017 to June 2017 were enrolled in this study;clinical features and laboratory data including patients’age,gender and previous history,C-reactive protein,blood glucose,liver and kidney functions,cardiac function indicators,combined diseases and combined drugs were recorded.Evaluation of related bleeding risk factors using univariate analysis of variance and multivariate regression analysis.Results:A total of 23 patients(11.4%)had bleeding during hospitalization,178(88.6%)had no bleeding,and the incidence of rivaroxaban-induced bleeding was 11.4%(23/201).Patients with coronary heart disease were found to be significantly associated with bleeding events associated with rivaroxaban(P=0.001,OR=4.013,95%CI 1.634 to 9.859).In addition,combined use of aspirin or clopidogrel increased bleeding risk significantly(P=0.001,OR=5.111,95%CI 1.961 to 13.319;P=0.001,OR=5.490,95%CI 2.150 to 14.017).Combined use of clopidogrel(P=0.029,OR=3.281,95%CI 1.129 to 9.531)and PT>13.0(P=0.034,OR=2.914,95%CI 1.082 to 7.851)increased the bleeding risk of rivaroxaban significantly.Conclusion:Coronary heart disease and combination use of antiplatelet drugs(aspirin and clopidogrel)were significantly associated with bleeding events caused by rivaroxaban.Multivariate regression showed that concomitant use of clopidogrel and PT>13.0 were independent risk factors for bleeding in patients with nonvalvular atrial fibrillation treaed with rivaroxaban.