利伐沙班治疗91例75岁以上房颤发生出血19例之分析

Analysis of rivaroxaban caused 19 patients with bleeding in treating 91 patients aged over 75 years with atrial fibrillation

目的探讨75岁以上老年非瓣膜房颤病人服用利伐沙班诱发出血不良反应发生情况并分析影响因素。方法回顾性分析南京医科大学附属老年医院2018年6月至2020年3月使用利伐沙班的91例临床基本特征,如年龄、出血史、基础疾病、肝肾功能、凝血指标及合并用药等。通过方差分析和多因素logistics回归分析考察出血相关不良反应的影响因素。结果91例病例中发生出血相关不良反应的有19例(20.88%)。方差分析结果显示卒中病史、恶性肿瘤病史、既往出血史、房颤血栓栓塞风险评分(CHA2DS2-VASc评分)、抗凝出血危险评估(HAS-BLED评分)和联用选择性5-羟色胺再摄取抑制剂(SSRIs)是利伐沙班相关出血的影响因素。多因素logistic回归分析显示恶性肿瘤病史(P=0.029,OR=1.530,95%CI:1.348~284.904)和既往出血史(P=0.021,OR=9.318,95%CI:1.397~62.154),合用SSRIs(P=0.004,OR=49.502,95%CI:3.492~701.806)是出血的独立预测因子。结论75岁以上老年房颤病人既往有出血史、恶性肿瘤、合用SSRIs时服用利伐沙班应注意出血不良反应的发生。

Objective To explore the incidence of rivaroxaban caused bleeding in patients aged over 75 years with non-valvular atrial fibrillation,and to analyze the influencing factors.Methods The cases of 91 patients who had atrial fibrillation in Geriatric Hospital of Nanjing Medical University from June 2018 to March 2020 were selected as the research object,and the clinical basic characteristics of patients were recorded,such as gender,age,weight,bleeding history,underlying diseases,liver and kidney function,coagulation indicators and combined medication.The influencing factors of bleeding-related adverse reactions were investigated by variance analysis and multivariate logistics regression analysis.Results history of stroke,malignant tumor,past bleeding history,CHA2 DS2-VASC score,HAS-BLED score and combined selective serotonin reuptake inhibitors(SSRIs)were influential factors for rivaroxaban-related bleeding.Multivariate Logistic regression analysis showed that history of malignancy[P=0.029,OR=1.530,95%CI(1.348,284.904)]and bleeding history[P=0.021,OR=9.318,95%CI(1.397,62.154)],and combined with SSRIs[P=0.004,OR=49.502,95%CI(3.492,701.806)]were independent predictors of bleeding.Conclusion Patients aged over 75 years with atrial fibrillation have a history of bleeding,malignant tumors and combination with SSRIs,they should be paid attention to the occurrence of bleeding adverse reactions when taking rivaroxaban.