达比加群酯及华法林对老年非瓣膜性心房颤动抗凝指标的影响及不良反应比较

Comparison of anticoagulant indexes and adverse reactions of dabigatran etexilateand warfarin in elderly patients with nonvalvular atrial fibrillation

目的探讨达比加群酯对老年非瓣膜性心房颤动抗凝指标及不良反应的影响。方法2017年1月~2019年8月诊治老年非瓣膜性心房颤动患者118例,随机分观察组及对照组,各59例,对照组应用华法林,每次2.5 mg,口服,qd,根据INR检测结果调整华法林剂量水平,使INR保持在2~3之间。观察组应用达比加群酯,根据内生肌酐清除率Ccr水平确定使用剂量,Ccr>30 ml/min时,每次150 mg,每天2次;Ccr<30 ml/min时,每次75 mg,2次/天,胶囊整吞,禁止咀嚼、掰开或压碎,疗程1年。结果治疗前两组非瓣膜性心房颤动患者凝血指标无差异(P>0.05),治疗1年后观察组PT(14.53±1.97)s、TT(26.22±3.15)s、APTT(44.23±4.28)s、INR(2.60±0.34),高于对照组的PT(12.85±1.80)s、TT(22.17±3.43)s、APTT(38.60±4.55)s、INR(2.13±0.28)(P<0.05);观察组出血事件3.39%、栓塞事件3.39%,低于对照组18.64%、16.95%(P<0.05),观察组不良反应发生率与对照组(22.03%vs.25.42%)无差异(P>0.05)。结论老年非瓣膜性心房颤动患者临床治疗采用达比加群酯,能显著改善凝血功能,临床治疗不良事件发生率较低。

Objective To investigate the effect of dabigatran etexilateon anticoagulation indexes and adverse reactions in elderly patients with nonvalvular atrial fibrillation.Methods From January 2017 to August 2019,118 patients with nonvalvular atrial fibrillation were randomly divided into observation group and control group,59 cases in each group.The control group was treated with warfarin,2.5mg/time,qd.Warfarin dosage level was adjusted according to INR test results to keep INR between 2~3.The observation group was given dabigatran etexilate,and the dosage was determined according to the level of Ccr.When Ccr>30 ml/min,the dosege was 150 mg/time,twice a day;when Ccr<30 ml/min,75 mg/time,2 times/day,the capsule was swallowed completely,Chewing,breaking or crushing were forbidden,and the course of treatment was 1 year.Results Before treatment,there was no difference in coagulation indexes between the two groups(P>0.05).After 1 years of treatment,the observation group PT(14.53±1.97)s、TT(26.22±3.15s、APTT(44.23±4.28)s、INR(2.60±0.34)were higher than those of the control group(12.85±1.80)s,TT(22.17±3.43)s,APTT(38.60±4.55)s,INR(2.13±0.28)(P<0.05).The bleeding events and Embolism Events in the observation group were 3.39%and 3.39%respectively,which were lower than 18.64%and 16.95%in the control group(P<0.05).There was no difference in adverse reactions of the two groups(22.03%vs.25.43%)(P>0.05).Conclusion Dabigatran etexilate can significantly improve coagulation function in patients with nonvalvular atrial fibrillation.The incidence of adverse events in clinical treatment is low,which has the advantages of clinical promotion and application.