高龄老年患者抗凝安全性及其影响因素分析

Analysis of Anticoagulant Safety and Its Influencing Factors in Elderly Patients

目的:探讨高龄老年患者抗凝治疗的安全性及其影响因素,为临床合理用药提供参考。方法:选入2019年3月~2021年3月在我院老年科一病区接受抗凝治疗的128例高龄(≥80岁)老年患者作为研究对象,收集患者一般资料、病史、合并用药等,并对其进行3~12个月的随访,记录国际标准化比率(INR)以及出血、缺血性脑卒中等不良事件的发生情况,并分析其影响因素。结果:128例患者共有不良事件39例(30.47%),其中出血26例(20.31%),新发缺血性脑卒中3例(2.34%),PT高值2例(1.56%),死亡11例(8.59%)(其中2例大出血死亡,1例缺血性脑卒中死亡);Logistic多因素回归分析结果显示:患者性别、合用激素、合用抗血小板药以及新发恶性肿瘤是高龄老年患者抗凝治疗后发生不良事件的独立影响因素(P<0.05)。结论:高龄老年患者根据综合评估后,采用小剂量、常规剂量等不同抗凝方案进行治疗均是合理的选择,其疗效及安全性无明显差异;但对于女性、合用激素和血小板药以及新发恶性肿瘤的患者要警惕不良事件的发生。

Objective: To explore the safety and influencing factors of anticoagulant therapy in elderly patients, and to provide reference for clinical rational drug use. Methods: 128 elderly patients(≥80 years old) who received anticoagulant therapy in the first ward of geriatrics department of our hospital from March 2019 to March 2021 were selected as the research object. The general data, medical history and combined medication of the patients were collected and followed up for 3~12 months. The international standardized ratio(INR) and the incidence of adverse events such as hemorrhage and ischemic stroke were recorded, and the influencing factors were analyzed. Results: There were 39 adverse events(30.47 %) in 128 patients, including 26 cases of bleeding(20.31 %), 3 cases of new ischemic stroke(2.34 %), 2 cases of high PT value(1.56 %) and 11 cases of death(8.59 %)(including 2 cases of massive bleeding and 1case of ischemic stroke). The results of logistic multiple regression analysis showed that gender, combined hormones, combined antiplatelet drugs and new-onset malignant tumor were the independent influencing factors of adverse events in elderly patients after anticoagulant treatment(P<0.05). Conclusion: According to the comprehensive evaluation, it is a reasonable choice for elderly patients to adopt different anticoagulation schemes such as low dose and routine dose, and there is no significant difference in efficacy and safety.However, for women, patients with hypertension, combined with hormone and platelet drugs, new-onset malignant tumor, we should be alert to the occurrence of adverse events.