利伐沙班用于超高龄非瓣膜性房颤患者的安全性评价

Safety of rivaroxaban in extremely elderly patients with non-valvular atrial fibrillation

目的:观察超高龄非瓣膜性房颤(non-valvular fibrillation, NVAF)患者临床特点和抗凝治疗安全性。方法:回顾性分析武汉市第三医院2020年5月至2021年4月接受利伐沙班抗凝治疗的NVAF患者,根据年龄分为观察组(年龄≥80岁)和对照组(<80岁)。观察2组患者发生缺血性脑卒中、心肌梗死、全身性栓塞、大出血及死亡事件的风险。结果:116人完成随访,观察组59人,对照组57人。所有患者至少合并1种慢性疾病,低体质量和肾功能不全是超高龄NVAF患者的生理特点。93.2%患者服用低于标准剂量的利伐沙班,52.5%患者有高或中等依从性。随访结束,2组患者缺血事件、大出血、临床相关非大出血和死亡事件的发生率相似。结论:对于超高龄NVAF患者应充分评估卒中风险和出血风险,低于标准剂量利伐沙班能否达到预期效果需进一步研究。

OBJECTIVE To observe the clinical characteristics and the safety of anticoagulation therapy in elderly patients with non-valvular atrial fibrillation(NVAF).METHODS Retrospective analysis was made on NVAF patients in Wuhan Third Hosppital who received anticoagulation therapy of rivalsaban from May 2020 to April 2021.They were divided into observation group(≥80 years old)and control group(<80 years old)according to age.Observe the risk of ischemic stroke, myocardial infarction, systemic embolism, massive hemorrhage and death in the two groups.RESULTS Follow-up was completed in 116 patients with NVAF who were taking rivaroxaban.All patients had at least one chronic disease.Low body weight and renal insufficiency are physiologic characteristics of the extremely elderly patients with NVAF.Overall, 93.2% of patients received 10 mg once daily.52.5% of patients had high or intermediate adherence to rivaroxaban, with similar risks of ischemic complications, major bleeding, non-major clinically relevant bleeding, and death compared to the control group.There were even no significant differences between the groups about the outcomes at a low dose of rivaroxaban.CONCLUSION The risk of stroke, bleeding and complications should be fully assessed in extremely elderly patients with NVAF.Whether the low dose of rivaroxaban can achieve the desired effects needs further study.