低剂量利伐沙班应用于非瓣膜性房颤合并急性冠脉综合征患者的有效性和安全性研究

Efficacy and safety of low-dose rivaroxaban in patients with non valvular atrial fibrillation complicated with acute coronary syndrome

目的对低剂量利伐沙班应用于非瓣膜性房颤合并急性冠脉综合征患者的有效性和安全性进行研究。方法选取新疆医科大学第二附属医院2019年3月-2021年6月期间收录的房颤(Atrial fibrillation,AF)合并急性冠脉综合征(Acute coronary syndrome,ACS)患者106例,采取利伐沙班药物抗凝治疗,根据给药剂量的不同分为高剂量组(n=58)和低剂量组(n=48),对比分析两组患者的治疗效果、治疗前后凝血功能指标情况、心肌生物标志物情况和治疗后的心血管不良事件(Major adverse cardiovascular events,MACE)发生情况。结果两组患者治疗后的PT、PTT、TT等凝血指标均有所升高,FIB有所下降,组内治疗前后对比,差异具有统计学意义(P<0.05);两组患者治疗后的CK-MB、cTnI等心肌生物标志物均有所下降,组内治疗前后对比,差异具有统计学意义(P<0.05);且低剂量组治疗后各指标的变化程度比高剂量组更大,两组对比,差异具有统计学意义(P<0.05)。低剂量组治疗后的MACE发生率为4.17%,高剂量组为18.97%,低剂量组的MACE发生率低于高剂量组,两组对比,差异具有统计学意义(P<0.05)。结论低剂量利伐沙班应用于AF合并ACS相比高剂量安全性更高,能减少不良反应和出血事件,可更好地保护肝肾功能。

Objective To study the efficacy and safety of low-dose rivaroxaban inpatients with non valvular atrial fibrillation complicated with acute coronarysyndrome.Methods 106 patients with atrial fibrillation(AF)complicated with acute coronary syndrome(ACS)collected in our hospital from March 2019 to June 2021 were treated with rivaroxaban.They were divided into high-dose group(n=58)and low-dose group(n=48)according to the dosage.The therapeutic effect,coagulation function indexes before and after treatment,and Myocardial biomarkers and the occurrence of major adverse cardiovascular events(MACE)after treatment.Results After treatment,PT,PTT,TT and other coagulation indexes of the two groups increased,and FIB decreased.The difference between the two groups before and after treatment was statistically significant(P<0.05);CK-MB,cTnI and other myocardial biomarkers in the two groups decreased after treatment,and the difference between the two groups before and after treatment was statistically significant(P<0.05);and the change degree of each index in the low-dose group after treatment was greater than that in the high-dose group,and the difference between the two groups was statistically significant(P<0.05).The incidence of MACE after treatment in the low-dose group was 4.17%,while in the high-dose group it was 18.97%.The incidence of MACE in the low-dose group was lower than that in the high-dose group,and the difference between the two groups was statistically significant(P<0.05).Conclusion Low-dose rivaroxaban is safer than high-dose rivaroxaban in AF complicated with ACS,which can reduce adverse reactions,reduce bleeding events and better protect liver and kidney function.