不同剂量利伐沙班预防老年非瓣膜性房颤患者脑卒中临床对比

Clinical comparison of different doses of rivaroxaban in the prevention of stroke in elderly patients with non-valvular atrial fibrillation

目的 分析不同剂量利伐沙班对预防老年非瓣膜性房颤患者脑卒中的临床效果。方法 选取2019年4月至2020年3月间浙江省台州市第一人民医院收治的105例缺血性脑卒中合并非瓣膜性房颤患者为研究对象,以区组随机化法将其分为对照组、大剂量组与小剂量组,每组各35例。对照组采取华法林治疗,大剂量组患者在对照组基础治疗上联合20 mg/d利伐沙班治疗,小剂量组患者在对照组基础治疗上联合10 mg/d利伐沙班,比较三组患者的栓塞事件发生率、出血事件发生率及不良反应发生率。结果 治疗后,小剂量组患者的栓塞事件发生率、出血事件发生率分别为8.57%、2.85%,均显著低于对照组(34.29%、8.57%)与大剂量组(17.14%、5.71%),差异有统计学意义(P<0.05);小剂量组患者不良反应发生率均显著低于对照组与大剂量组,差异有统计学意义(P<0.05);对照组和大剂量组两组不良反应发生率比较,差异无统计学意义(P>0.05);治疗后,三组患者的INR值、凝血酶原时间比较,差异无统计学意义(P>0.05)。结论 小剂量的利伐沙班可有效预防老年非瓣膜性房颤患者发生脑卒中,且作用迅速,治疗依从性高,较华法林使用更为方便,对患者预后产生相应的积极影响。

Objective To analyze the clinical effect of different doses of rivaroxaban in the prevention of stroke in elderly patients with non-valvular atrial fibrillation. Methods A total of 105 patients with ischemic stroke complicated with non-valvular atrial fibrillation admitted to Taizhou First People′s Hospital in Zhejiang Province from April 2019 to March 2020 were selected as the study subjects and divided into the control group, high-dose group, and low-dose group by block randomization, with 35 cases in each group. The patients in the control group were treated with warfarin. The patients in the high-dose group were treated with 20 mg/day of rivaroxaban based on the basic treatment of the control group. The patients in the low-dose group were treated with 10 mg/day of rivaroxaban based on the basic treatment of the control group. The incidence rate of embolic events, bleeding events, and adverse reactions were compared among the three groups. Results After treatment, the incidence rate of embolic events and bleeding events in the low-dose group were 8.57% and 2.85%, respectively, which were significantly lower than those in the control group(34.29%, 8.57%) and high-dose group(17.14%, 5.71%), with significant difference(P<0.05). The adverse reactions in the low-dose group were significantly lower than those in the control group and high-dose group, with significant difference(P<0.05). There was no significant difference in the incidence rate of adverse reactions between the control and high-dose groups(P>0.05). After treatment, there was no significant difference in INR value and prothrombin time among the three groups(P>0.05). Conclusion Low-dose rivaroxaban can effectively prevent stroke in elderly patients with non-valvular atrial fibrillation, with rapid effect and high treatment compliance. It is more convenient than warfarin and has a positive impact on the prognosis of patients.