利伐沙班联合阿托伐他汀治疗非瓣膜性心房颤动合并急性缺血性卒中患者的疗效

Efficacy of rivaroxaban combined with atorvastatin in patients with non-valvularatrial fibrillation complicated with acute ischemic stroke

目的探讨利伐沙班联合阿托伐他汀治疗非瓣膜性心房颤动(NVAF)合并急性缺血性卒中(AIS)患者的疗效和安全性。方法纳入NVAF合并AIS患者200例,分为利伐沙班+阿托伐他汀20 mg组(A组)、利伐沙班+阿托伐他汀40 mg组(B组)、氯吡格雷+阿托伐他汀20 mg组(C组)、氯吡格雷+阿托伐他汀40 mg组(D组),每组50例,配合低脂饮食治疗。监测患者治疗前(基线)、治疗2周后总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平,计算LDL-C达标率,观察1年药物不良反应和新发动脉粥样硬化性心血管疾病(ASCVD)事件发生情况。结果与基线比较,治疗2周后4组患者TC和LDL-C均显著降低,LDL-C达标率分别为26%、76%、24%和82%,1年内新发ASCVD事件发生率分别为12%、8%、20%和18%,A组、B组显著低于C组、D组(均P <0.05),A组和B组间无显著差异(P> 0.05)。安全性方面,4组不良反应发生率分别为8%、18%、6%和12%,组间比较无显著差异(χ~2=4.290,P=0.232)。结论 NVAF合并AIS患者低脂饮食配合利伐沙班及早期应用中、低剂量阿托伐他汀联合治疗,能有效降低LDL-C水平,预防1年内ASCVD事件发生,且安全性较好。

AIM To investigate the efficacy and safety of rivaroxaban combined with atorvastatin in the treatment of patients with non-valvular atrial fibrillation(NVAF) complicated with acute ischemic stroke(AIS). METHODS Two hundred patients with NVAF complicated with AIS were selected as the objects. The patients were divided into rivaroxaban + atorvastatin 20 mg group(group A), rivaroxaban + atorvastatin 40 mg group(group B), clopidogrel + atorvastatin 20 mg group(group C), clopidogrel + atorvastatin 40 mg group(group D), 50 cases in each group, with low-fat diet treatment. All selected patients were monitored for total cholesterol(TC) and low density lipoprotein-cholesterol(LDL-C) levels before treatment and 2 weeks after treatment, and the LDL-C compliance rate was calculated. Adverse drug reactions and new atherosclerotic cardiovascular disease(ASCVD) events were observed. RESULTS After 2 weeks of treatment, compared with the baseline, the control rate of LDL-C in the four groups was 26%, 76%, 24% and 82%, respectively. The incidence of new ASCVD events in 1 year was 12%, 8%, 20% and 18%, respectively, which in the group A and group B were significantly lower than those in the group C and group D(P < 0.05). There was no significant difference between the group A and group B(P > 0.05). The incidence of adverse reactions in the four groups was 8%, 18%, 6% and 12%, respectively. And there was no significant difference among the groups (χ~2 = 4.290, P = 0.232). CONCLUSION Given a low-fat diet plus rivaroxaban and early application of low-or moderate-dose atorvastatin, can effectively reduce LDL-C levels early and prevent the recurrence of ASCVD events in the NVAF combined with AIS patients, and the safety is better.