我院心源性脑卒中患者使用不同剂量利伐沙班的有效性与安全性研究

Effectiveness and Safety of Different Doses of Rivaroxaban in Cardioembolic Stroke Survivors

目的调查我院心源性脑卒中患者中利伐沙班临床使用剂量及对指南推荐剂量的相符率,并评价不同剂量利伐沙班的疗效与安全性。方法回顾性分析2017年1月1日至2021年12月31日间复旦大学附属华山医院神经内科使用利伐沙班的心源性脑卒中患者的病历资料,根据其处方剂量分为15~20 mg·d^(-1)剂量组和5~10 mg·d^(-1)剂量组,并通过电话随访的方式,收集比较两组患者出院后3个月临床结局、不良反应及用药情况。结果共纳入心源性脑卒中患者129例,其中15~20 mg·d^(-1)剂量组83例,5~10 mg·d^(-1)剂量组46例。本院利伐沙班临床使用剂量与指南推荐剂量的相符率仅21.70%(28/129例)。两组不同剂量的患者在年龄、体重、性别、HAS-BLED评分和CrCl上的差异具有统计学意义(P<0.05)。平衡两组间基线特征差异后,两组患者栓塞事件发生率、出血事件发生率和神经功能恢复情况上差异均无统计学意义(P>0.05)。结论真实世界心源性脑卒中患者利伐沙班临床使用剂量与指南推荐剂量的相符率较低,不同利伐沙班剂量组患者在栓塞风险、出血风险和神经功能恢复情况方面无显著性差异。年龄和性别可能是影响利伐沙班临床使用剂量的因素。

OBJECTIVE To analyze the coincidence rate of the dosage of rivaroxaban in the clinical with that recommended in guidelines in cardioembolic stroke(CES)survivors,and compare the efficacy and safety of different doses of rivaroxaban in the clinical practice.METHODS Using data from the Department of Neurology,Huashan Hospital,Fudan University between January 1,2017,and November 31,2021,a retrospective study was conducted in CES survivors who were treated with 15-20 mg·d^(-1)and 5-10 mg·d^(-1)rivaroxaban,and patients were followed up by phone for 3 mouth to collect clinical outcomes.RESULTS A total of 129 patients with CES were finally included,with 83 in 15-20 mg·d^(-1)group and 46 in 5-10 mg·d^(-1)group.According to the guidelines,the coincidence rate of the dosage of rivaroxaban was only 21.70%(28/129).Compared with the 15-20 mg·d^(-1)group,patients in the 5-10 mg·d^(-1)group were significantly different in the age,weight,gender,HAS-BLED score and CrCl(P<0.05).After balancing the characteristics between the two groups,there was no statistically significant difference in the incidence of embolism and bleeding events and the recovery of neurological function in the different doses of rivaroxaban groups(P>0.05).CONCLUSION A low coincidence rate of the doses of rivaroxaban with the guidelines recommended is found.And different doses of rivaroxaban are equivalent in terms of embolism risk,bleeding risk and recovery of neurological function.For the age and sex,clinicians are more inclined to choose low-dose(5-10 mg·d^(-1))rivaroxaban.