不同剂量利伐沙班联合氯吡格雷预防高危肺栓塞的效果

Different Doses of Rivaroxaban Combined with Clopidogrel to Prevent High-Risk Pulmonary Embolism

目的探讨不同剂量利伐沙班联合氯吡格雷预防高危肺栓塞(PE)的效果。方法选取2015年6月至2019年5月于沈阳市第四人民医院就诊经超声检查未发现血栓,但具有PE风险的患者158例作为研究对象,随机分为A组(39例)、B组(65例)、C组(54例)。A组采用利伐沙班(5 mg/次,1次/d)联合氯吡格雷(75 mg/次,1次/d)治疗;B组采用利伐沙班(10 mg/次,1次/d)联合氯吡格雷(75 mg/次,1次/d)治疗;C组采用利伐沙班(15 mg/次,1次/d)联合氯吡格雷(75 mg/次,1次/d)治疗。随访1年,统计3组患者疗效终点事件和安全性终点事件发生情况,比较3组治疗前及治疗后1年肝肾功能、血小板计数、血红蛋白和凝血功能。结果 3组患者疗效终点事件和安全性终点事件发生率比较差异无统计学意义(P>0.05);治疗前后3组患者丙氨酸转氨酶、肌酐、血小板计数、血红蛋白、活化部分凝血活酶时间(APTT)及凝血酶原时间比较,差异无统计学意义(P>0.05)。结论对于高龄老年高危PE患者应用5 mg利伐沙班联合氯吡格雷疗效确切,同时也相对安全。

Objective To explore the effect of different doses of rivaroxaban combined with clopidogrel in preventing high-risk pulmonary embolism(PE). Methods From June 2015 to May 2019, a total of 158 PE patients, not finding thrombosis after ultrasound examination in Shenyang Fourth People’s Hospital were selected as the research objects and were randomly divided into group A(39 cases) and group B(65 cases), group C(54 cases). Group A was treated with rivaroxaban(5 mg/time, once/d) combined with clopidogrel(75 mg/time, once/d);group B was treated with rivaroxaban(10 mg/time, once/d)/d) combined clopidogrel(75 mg/time, 1 time/d);group C was treated with rivaroxaban(15 mg/time, 1 time/d) combined with clopidogrel(75 mg/time, 1 time/d))treatment. Follow-up for 1 year, the 3 groups of patients’ efficacy endpoint events and safety endpoint events were counted, and liver and kidney function, platelet count, hemoglobin and blood coagulation function were compared in the 3 groups before treatment and 1 year after treatment. Results There was no significant difference in the incidence of efficacy endpoint events and safety endpoint events among the 3 groups of patients(P>0.05);before and after treatment, there were no statistically difference in alanine aminotransferase, creatinine, platelet count, hemoglobin, and activated partial thromboplastin time(APTT) and prothrombin time of the 3 groups of patients(P>0.05). Conclusion For elderly patients with high-risk PE, 5 mg rivaroxaban combined with clopidogrel has a definite effect and is relatively safe.