低剂量利伐沙班对老年非瓣膜性心房颤动患者的血栓栓塞与出血事件及再入院率的影响

Effect of low-dose rivaroxaban on thromboembolism,bleeding events and readmission rates in elderly patients with non-valvular atrial fibrillation

目的比较低剂量(10 mg/d)利伐沙班、15 mg/d利伐沙班和华法林对老年非瓣膜性心房颤动患者的血栓栓塞与出血事件及再入院率的影响。方法选择2020年1月1日至2021年8月31日于中国科学技术大学附属第一医院(安徽省立医院)心血管内科就诊的96例使用利伐沙班或华法林抗凝的老年非瓣膜性心房颤动患者,按用药种类及用药剂量分为10 mg/d利伐沙班组34例,15 mg/d利伐沙班组28例,华法林组34例;随访并记录用药1年内发生的血栓栓塞性事件和出血性事件及再入院的情况。并采用多元logistic回归分析评估3组患者用药后的出血风险。结果3组患者的血栓栓塞性事件总发生率相比较,差异无统计学意义(P>0.05);在出血事件方面,15 mg/d利伐沙班组相较于10 mg/d利伐沙班组和华法林组消化道出血的发生率增加,差异有统计学意义(P<0.05);10 mg/d利伐沙班组与华法林组消化道出血的发生率相比较,差异无统计学意义(P>0.05);多元logistic回归分析发现,在校正年龄、性别、体重指数、消化道疾病史等因素后,15 mg/d利伐沙班组消化道出血的风险较10 mg/d利伐沙班组高(OR=14.09,95%CI:1.180~168.730);3组患者的其他出血事件发生率、再入院率相比较,差异无统计学意义(P>0.05)。结论10 mg/d利伐沙班与15 mg/d利伐沙班、华法林对于老年非瓣膜性心房颤动患者的抗凝效果相当,15 mg/d利伐沙班与10 mg/d利伐沙班相比可能会增加老年非瓣膜性心房颤动患者消化道出血的风险。

Objective To compare the effects of low-dose(10 mg/d)rivaroxaban,15 mg/d rivaroxaban and warfarin on thromboembolic,bleeding events and readmission rates in elderly patients with non-valvular atrial fibrillation(NVAF).Methods From January 1,2020 to August 31,2021,96 elderly patients with non-valvular atrial fibrillation treated with rivaroxaban or warfarin anticoagulation in Department of Cardiovascular Medicine of Anhui Provincial Hospital were selected.According to the type of medication and dose,they were divided into low-dose(10 mg/d)rivaroxaban group(34 cases),15 mg/d rivaroxaban group(28 cases)and warfarin group(34 cases);the thromboembolic events,bleeding events and readmissions were recorded within one year of treatment.Results The differences were not statistically significant(P>0.05)when comparing the total incidence of thromboembolic events in the 3 groups;in terms of bleeding events,the incidence of gastrointestinal bleeding increased in the 15 mg/d rivaroxaban group compared with the low-dose(10 mg/d)rivaroxaban and warfarin groups,and the differences were statistically significant(P<0.05);the incidence of gastrointestinal bleeding in the low-dose(10 mg/d)rivaroxaban group compared with the warfarin group,and the differences were not statistically significant(P>0.05).The difference was not statistically significant when comparing the incidence of GI bleeding in the low-dose(10 mg/d)rivaroxaban group with that in the warfarin group(P>0.05);multivariate logistic regression analysis was used to evaluate the risk of bleeding in the three groups.and after correcting for age,sex,BMI,and history of GI disease,it was found that the risk of GI bleeding in the 15 mg/d group of rivaroxaban was higher than that in the 10 mg/d group(OR=14.09,95%CI:1.180-168.730);the differences were not statistically significant when comparing the incidence of other bleeding events and readmission rates among the three groups(P>0.05).Conclusions The anticoagulant effect of 10 mg/d rivaroxaban is similar to 15 mg/d rivaroxaban and warfarin in elderly patients with non-valvular atrial fibrillation.15 mg/d rivaroxaban compared with 10 mg/d rivaroxaban may increase the risk of gastrointestinal bleeding in elderly patients with non-valvular atrial fibrillation.