不同剂量利伐沙班对非瓣膜性房颤患者血栓栓塞与出血事件影响的研究

Effect of different doses of rivaroxaban on thromboembolism and bleeding in patients with non-valvular atrial fibrillation

目的比较按人口学特征给予不同剂量利伐沙班对非瓣膜性房颤患者血栓栓塞与出血事件的影响。方法选择2018年1月—2019年7月南京鼓楼医院心血管内科口服利伐沙班的非瓣膜性房颤患者,按处方剂量分为高(20 mg·d^(-1))、中(15 mg·d^(-1))、低(10 mg·d^(-1))剂量组。通过电话随访或患者门诊资料获取并记录用药一年间发生的血栓栓塞性事件和出血性事件。结果最终纳入360例患者并完成随访,20 mg·d^(-1)组,15 mg·d^(-1)组和10 mg·d^(-1)组分别纳入79例、219例和62例。3组患者在血栓栓塞性事件和出血性事件发生率方面差异无统计学意义(P>0.05)。10 mg·d^(-1)组血栓栓塞性事件6例,出血性事件7例;15 mg·d^(-1)组血栓栓塞性事件5例,出血性事件23例;20 mg·d^(-1)组血栓栓塞性事件1例,出血性事件3例。年龄、肾功能、冠心病病史是血栓栓塞与出血事件发生的危险因素,差异具有统计学意义(P<0.05)。结论不同剂量利伐沙班对于非瓣膜性房颤患者临床血栓栓塞性事件和出血性事件相当,证实对于年龄较大患者服用较低剂量(15 mg/10 mg)是可行的,同时应考虑肾功能、既往病史等因素,合理用药。

Objective To compare the effect of different doses of rivaroxaban on thromboembolism and bleeding events in patients with non-valvular atrial fibrillation according to various demographic data.Methods Patients with non-valvular atrial fibrillation who received oral rivaroxaban from January 2018 to July 2019 in the Department of Cardiology,Nanjing Drum Tower Hospital were selected and divided into high(20 mg·d^(-1)),medium(15 mg·d^(-1))and low(10 mg·d^(-1))dose groups according to prescription doses.Thromboembolic and bleeding events that occurred within one year of medication were recorded via phone follow-up or out patient data.Results Totally 360 patients were included,with 79,219 and 62 in the 20 mg·d^(-1) group,15 mg·d^(-1) group and 10 mg·d^(-1) group,respectively.There was no significant difference in the incidence of thromboembolic and bleeding events among the 3 groups(P>0.05).There were 6 thromboembolic events and 7 hemorrhagic events in the 10 mg·d^(-1) group,5 thromboembolic events and 23 hemorrhagic events in the 15 mg·d^(-1) group,and 1 thromboembolic event and 3 hemorrhagic events in the 20 mg·d^(-1) group.Age,renal function,and history of coronary heart disease were risk factors for the occurrence of the event,with statistically difference(P<0.05).Conclusion Different doses of rivaroxaban do not make much difference to clinical thromboembolic and bleeding events among patients with non-valvular atrial fibrillation.It is feasible to prescribe low dose(15 mg/10 mg)for older patients.At the same time,factors such as renal function and past medical history should be considered.