3种抗凝药物在老年房颤病人中的疗效和安全性评价

Efficacy and safety of three anticoagulants in elderly patients with atrial fibrillation

目的比较≥65岁老年房颤病人服用华法林、达比加群酯与利伐沙班抗凝的安全性及有效性,为临床决策提供参考。方法选取2015~2019年在本院住院治疗的非瓣膜性房颤病人,根据年龄分为65~74岁、75~84岁、≥85岁3组,并记录所有对象抗凝治疗方案(华法林、达比加群酯或利伐沙班),随访至2020年12月31日或首次出现任何栓塞、出血事件或死亡,比较3种抗凝方案终点事件的发生率。结果截至2020年12月31日,最终入组病人581例,其中女292例(50.26%);65~74岁293例(50.43%),75~84岁253例(43.55%),≥85岁35例(6.02%);应用华法林301例,达比加群酯119例,利伐沙班161例。不同抗凝药物组病人卒中及大出血事件发生率差异有统计学意义;华法林组小出血及栓塞风险较达比加群酯组高,差异有统计学意义(P<0.05)。按年龄分层分析,结果显示75~84岁组华法林栓塞及出血发生率最高,达比加群酯最低,差异均有统计学意义(P<0.05),65~74岁组以及≥85岁组不同抗凝药物栓塞及出血率差异均无统计学意义。结论3种抗凝药物均可使老年房颤病人获益,在75~84岁的老年病人中,华法林安全性和有效性均低于达比加群酯和利伐沙班,服用达比加群酯者出血率最低。

Objective To compare the safety and effectiveness of warfarin,dabigatran and rivaroxaban in the elderly patients with atrial fibrillation aged 65 years old and above,and to provide a reference for clinical decision-making.Methods The elderly patients with non-valvular atrial fibrillation who were hospitalized in our hospital from 2015 to 2019 were enrolled in the study.The patients were divided into three groups as 65-74 years old group,75-84 years old group,and≥85 years old group according to their ages,and divided into warfarin group,dabigatran group,and rivaroxaban group according to the anticoagulant treatment plan.They were followed up until the first occurrence of any embolism,bleeding event or death and the end of the study(12/31/2020).The incidence rate of end-point events among the three groups was compared.Results A total of 581 patients were finally enrolled in this study.Among them 292 were female(50.26%);293 cases(50.43%)were 65-74 years old,253 cases(43.55%)were 75-84 years old,35 cases were≥85 years old(6.02%);301 cases received warfarin,119 cases received dabigatran,and 161 cases received rivaroxaban.There was statistically significant difference in stroke and hemorrhoea events among different anticoagulant groups.Warfarin group had a higher risk of bleeding and embolism than dabigatran group(all P<0.05);Stratified by age,the patients receiving Warfarin in 75-84 years old group had the highest incidence rate of embolization and bleeding,followed by the patients receiving rivaroxaban and dabigatran(P<0.05).The incidence rate of embolism and bleeding had no statistical difference between different anticoagulant groups in 65-74 years old group and≥85 years old group.Conclusions Three anticoagulant drugs show value in the elderly patients with atrial fibrillation.In elderly patients aged 75-84 years old,the safety and effect of warfarin are lower than dabigatran and rivaroxaban.