不同剂量利伐沙班治疗高龄PCI术后合并心房颤动患者的有效性和安全性比较

Comparison of Effectiveness and Safety of Different Doses of Rivaroxaban in Treatment of Elderly Patients with Atrial Fibrillation after PCI

目的比较不同剂量利伐沙班治疗高龄经皮冠状动脉介入术(PCI)术后合并心房颤动患者的有效性和安全性。方法选取2019年6月至2020年6月于上海中医药大学附属宝山医院行PCI术后合并心房颤动的90例高龄患者为研究对象,按照治疗方法不同分为三组,每组30例。小剂量组术后给予5~7.5 mg/d利伐沙班治疗;常规剂量组术后给予10 mg/d利伐沙班治疗;大剂量组术后给予15 mg/d利伐沙班治疗。比较三组患者的临床疗效、凝血功能、血栓栓塞事件发生率、出血事件发生率、肝肾功能、药物不良反应发生率。结果三组临床疗效比较差异无统计学意义(P>0.05)。D-二聚体的组间和时点间存在交互作用(P<0.01),治疗后三组D-二聚体均降低,但三组治疗后D-二聚体水平比较差异无统计学意义(P>0.05);三组粪便隐血阳性率比较差异无统计学意义(P>0.05)。治疗期间,三组血栓栓塞事件和总出血事件发生率比较差异无统计学意义(P>0.05)。丙氨酸转氨酶、天冬氨酸转氨酶的组间和时点间存在交互作用(P<0.01),治疗后三组丙氨酸转氨酶、天冬氨酸转氨酶水平均升高,且大剂量组丙氨酸转氨酶、天冬氨酸转氨酶水平高于小剂量组及常规剂量组(P<0.05)。治疗期间,三组总药物不良反应发生率比较差异无统计学意义(P>0.05)。结论对于高龄PCI术后合并心房颤动患者,临床给予不同剂量利伐沙班治疗均有效,且用药安全性较好。但综合考虑高龄患者估算的肾小球滤过率、肝功能及体重等因素,临床首选常规剂量利伐沙班进行抗凝治疗。

Objective To compare the effectiveness and safety of different doses of rivaroxaban in the treatment of elderly patients with atrial fibrillation after percutaneous coronary intervention(PCI).Methods A total of 90 elderly patients with atrial fibrillation after PCI in Baoshan Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from Jun.2019 to Jun.2020 were included,and they were divided into three groups according to different treatment methods,with 30 cases in each group.The low-dose group was given 5 to 7.5 mg/d rivaroxaban after operation;the conventional-dose group was given 10 mg/d rivaroxaban after operation;the high-dose group was given 15 mg/d rivaroxaban after operation.The clinical efficacy,coagulation function,incidence of thromboembolic events,incidence of bleeding events,liver and kidney function,and incidence of adverse drug reactions of the three groups were compared.Results There was no significant difference in clinical efficacy among the three groups(P>0.05).There were interactions of D-dimer between groups and time points(P<0.01),and D-dimer levels in all three groups decreased after treatment,but there was no statistically significant difference in D-dimer levels among the three groups after treatment(P>0.05).There was no significant difference in fecal occult blood positive rate among the three groups(P>0.05).During treatment,there was no significant difference in the incidence of thromboembolic events and total bleeding events among the three groups(P>0.05).There were interactions in the levels of alanine aminotransferase and aspartate aminotransferase between groups and time points(P<0.01),which were all increased after treatment(P<0.01),and the levels of alanine aminotransferase and aspartate aminotransferase in the high-dose group were higher than those in the low-dose group and the conventional-dose group(P<0.05).During treatment,there was no significant difference in the incidence of total adverse drug reactions among the three groups(P>0.05).Conclusion For elderly patients with atrial fibrillation after PCI,clinical treatment with different doses of rivaroxaban is effective with good safety.However,considering the estimated glomerular filtration rate,liver function and body weight and other factors in the elderly patients,the routine dose of rivaroxaban should be the optimal selection for anticoagulation therapy.