不同剂量利伐沙班对非瓣膜性房颤抗凝效果的影响

Effect of Different Doses of Rivaroxaban on Anticoagulation in Patients with Nonvalvular Atrial Fibrillation

目的分析不同剂量利伐沙班对非瓣膜性房颤(NVAF)抗凝效果的影响。方法采用回顾性队列研究方法。收集医院心内科病区2017年3月至6月收治的201例接受利伐沙班抗凝治疗并拟行射频消融术的NVAF住院患者临床资料,采用单因素方差分析和多因素回归分析法评估不同剂量利伐沙班对NVAF患者的抗凝效果。结果患者的平均年龄[OR=5.573,95%CI(2.621,8.525),P<0.001],年龄≥65岁比例[OR=0.310,95%CI(0.162,0.594),P<0.001],预测肾小球滤过率(eGFR)水平(P=0.002),肾功能不全患者比例[OR=0.273,95%CI(0.126,0.593),P=0.001],房颤血栓危险度(CHA_(2)DS_(2)-VASc)评分(P=0.025)与利伐沙班用量显著相关;合并冠心病[OR=0.512,95%CI(0.280,0.937),P=0.029],联用阿司匹林[OR=0.102,95%CI(0.029,0.356),P<0.001]、氯吡格雷[OR=0.153,95%CI(0.055,0.423),P<0.001]、他汀类药物[OR=0.467,95%CI(0.265,0.823),P=0.008]、胺碘酮[OR=5.729,95%CI(2.106,15.586),P<0.001]、质子泵抑制剂[OR=1.909,95%CI(1.088,3.351),P=0.024]等药物的低剂量组和高剂量组有显著差异。使用不同剂量利伐沙班后患者凝血功能指标均在正常范围内,无须监测。患者住院期间共23例(11.44%)发生出血,研究后发现,利伐沙班引起的出血风险与其日剂量显著相关[OR=0.786,95%CI(0.637,0.970),P=0.025];此外,联用阿司匹林[OR=7.700,95%CI(1.150,51.556),P=0.035]和出血风险评分升高[OR=2.305,95%CI(1.044,5.091),P=0.039]可显著增加使用利伐沙班相关出血风险。结论利伐沙班日剂量、联用抗血小板药物和出血风险评分是导致NVAF患者出血的危险因素。

Objective To analyze the effect of different doses of rivaroxabanon on anticoagulation in patients with nonvalvular atrial fibrillation(NVAF).Methods A retrospective cohort study was adopted.The clinical data of 201 patients with NVAF who received rivaroxaban anticoagulation therapy and planned to undergo radiofrequency ablation in the Department of Cardiology of our hospital from March to June 2017 were collected,and the anticoagulation effect of different doses of rivaroxaban on anticoagulation in patients with NVAF was evaluated by univariate analysis of variance and multivariate regression analysis.Results The average age of patients[OR=5.573,95%CI(2.621,8.525),P<0.001]and the proportion of patients with age≥65 years old[OR=0.310,95%CI(0.162,0.594),P<0.001],estimated glomerular filtration rate(eGFR,P=0.002),and the proportion of patients with renal insufficiency[OR=0.273,95%CI(0.126,0.593),P=0.001],CHA_(2)DS_(2)-VASc score(P=0.025)were significantly correlated with the dose of rivaroxaban.There were significant differences in patients with coronary heart disease[OR=0.512,95%CI(0.280,0.937),P=0.029],the combination of aspirin[OR=0.102,95%CI(0.029,0.356),P<0.001],clopidogrel[OR=0.153,95%CI(0.055,0.423),P<0.001],statins[OR=0.467,95%CI(0.265,0.823),P=0.008],amiodarone[OR=5.729,95%CI(2.106,15.586),P<0.001],proton pump inhibitors[OR=1.909,95%CI(1.088,3.351),P=0.024]between low-dose group and high-dose group.After administration of different doses of rivaroxaban,the coagulation function indexes were in the normal range,which need not be detected.A total of 23 patients(11.44%)had bleeding during hospitalization,and the analysis result showed that the risk of rivaroxaban-induced bleeding was significantly correlated with its daily dose[OR=0.786,95%CI(0.637,0.970),P=0.025].In addition,the combination of aspirin[OR=7.700,95%CI(1.150,51.556),P=0.035]and increased HAS-BLED score[OR=2.305,95%CI(1.044,5.091),P=0.039]could significantly increase the risk of rivaroxaban-induced bleeding.Conclusion Daily dose of rivaroxaban,the combination of antiplatelet drugs and HAS-BLED score are risk factors for bleeding in patients with NVAF.