心房颤动患者应用华法林和利伐沙班颅内出血风险的比较

Comparison of the Risk of Intracranial Hemorrhage between Warfarin and Rivaroxaban in Patients with Atrial Fibrillation

目的:比较应用华法林和新型抗凝药利伐沙班的心房颤动(AF)患者发生颅内出血(ICH)的风险。方法:回顾性选取2017年1月~2019年6月于本院住院治疗的非瓣膜性AF患者381例作为研究对象,根据服用抗凝药物种类分为华法林组(n=207)和利伐沙班组(n=174)。记录患者的人口统计学特征、检查检验结果,采用多因素Logistic回归方法分析影响ICH的危险因素。结果:华法林组收缩压水平、高血压、血脂异常比例高于利伐沙班组,血小板计数少于利伐沙班组(P<0.05)。两组间的年龄、性别、舒张压、心率、体重指数(BMI)、糖尿病、吸烟、饮酒、肌酐、国际标准化比值(INR)比较无统计学差异(P>0.05)。华法林组(21例)与利伐沙班组(13例)ICH事件比较具有统计学差异(P<0.05)。Logistic回归分析结果显示,应用华法林是ICH的危险因素。结论:相较于华法林,应用利伐沙班可降低AF患者ICH风险。

Objective:To compare the risk of intracranial hemorrhage(ICH)in patients with atrial fibrillation(AF)treated with warfarin and the novel oral anticoagulant rivaroxaban.Methods:A total of 381 patients with non-valvular atrial fibrillation hospitalized in our hospital from January 2017 to June 2019 were retrospectively selected as the research subjects and divided into warfarin group(n=207)and rivaroxaban group(n=174)according to the types of anticoagulant.The demographic characteristics of the patients and examination test results were recorded.Multivariate Logistic regression was used to analyze the risk factors of ICH.Results:The systolic blood pressure,proportion of hypertension,and dyslipidemia was significantly higher in the warfarin group than that in the rivaroxaban group,while the platelet count in the warfarin group was significantly less than that in the rivaroxaban group(P<0.05).There were no significant differences in age,gender,diastolic blood pressure,heart rate,body mass index(BMI)diabetes mellitus,smoking,alcohol consumption,creatinine,and international normalized ratio(INR)between the two groups(P>0.05).Comparison of the ICH events between two groups,there were 21 cases in the warfarin group and 13 cases in the rivaroxaban group,with statistically significant differences between the two groups(P<0.05).Logistic regression analysis showed that the application of warfarin was the greatest risk factor for ICH.Conclusion:Compared with warfarin,the application of rivaroxaban can significantly reduce the risk of ICH in patients with atrial fibrillation.