利伐沙班在高龄心力衰竭合并房颤抗凝治疗中的剂量优化研究

doi:10.3969/j.issn.1003-9198.2022.10.013

摘要/Abstract

摘要： 目的研究利伐沙班在高龄心力衰竭合并心房颤动(房颤)抗凝治疗中的最佳剂量。方法回顾性收集2018年2月至2021年2月我院85例高龄(>80岁)心力衰竭合并房颤病人的临床资料,按照利伐沙班的处方剂量分为低剂量组(5 mg/d,n=25)、中剂量组(10 mg/d,n=41)和高剂量组(20 mg/d,n=19)。比较3组治疗前、治疗1个月后凝血功能指标[凝血酶原时间(PT)、D-二聚体(D-D)]及心功能指标[LVEF、肺动脉压(PAP)、N末端B型钠尿肽前体(NT-proBNP)],并随访6个月,统计栓塞事件及出血事件发生情况。结果治疗前、治疗后3组间PT、D-D比较,差异均无统计学意义(P＞0.05);治疗后3组PT均长于治疗前,D-D水平均低于治疗前(P＜0.05);治疗前、治疗后3组间LVEF、PAP、NT-proBNP比较,差异均无统计学意义(P＞0.05);治疗后3组LVEF均大于治疗前,PAP、NT-proBNP水平均低于治疗前(P＜0.05)。随访6个月,中剂量组栓塞事件发生率低于低剂量组(P＜0.05),出血事件发生率低于高剂量组(P＜0.05)。结论对于高龄心力衰竭合并房颤病人,采用利伐沙班治疗能改善凝血功能及心功能,且10 mg/d可能为高龄心力衰竭合并房颤病人抗凝治疗的最佳剂量。

关键词: 高龄, 心力衰竭, 心房颤动, 利伐沙班, 剂量优化

Abstract: Objective To study the dose optimization of rivaroxaban in the anticoagulant treatment of heart failure complicated with atrial fibrillation in the patients aged ＞80 years. Methods The clinical data of 85 elderly patients with heart failure complicated with atrial fibrillation in our hospital from February 2018 to February 2021 were collected retrospectively. According to the prescription dose of rivaroxaban, they were divided into low dose group (5 mg/d, n=25), medium dose group (10 mg/d, n=41) and high dose group (20 mg/d, n=19). The indexes of coagulation function [prothrombin time (PT), D-dimer (D-D)] and cardiac function [left ventricular ejection fraction (LVEF), pulmonary artery pressure (PAP), N-terminal B-type natriuretic peptide precursor (NT-proBNP)] were compared before treatment and 1 month after treatment, and all patients were followed up for 6 months. Results There were no significant differences in PT and D-D between the three groups before and after treatment (P>0.05). After treatment, the level of PT was longer and the level of D-D was lower than that before treatment in the three groups (P< 0.05). There were no significant differences in the levels of LVEF, PAP and NT-proBNP between the three groups before and after treatment (P>0.05). After treatment, the level of LVEF in the three groups was higher than that before treatment, and the levels of PAP and NT-proBNP were lower than those before treatment (P<0.05). In the middle dose group, the total embolism rate was lower than that in the low dose group (P<0.05), while the total incidence rate of bleeding was lower than that in the high dose group (P<0.05). Conclusions For elderly patients with heart failure complicated with atrial fibrillation, rivaroxaban can improve the coagulation function and cardiac function, and 10 mg/d may be the best dose of anticoagulant therapy.

Key words: aged, heart failure, atrial fibrillation, rivaroxaban, dose optimization

中图分类号:

R541

许宇文, 刘琼, 沈琼, 朱琰, 方宏钧. 利伐沙班在高龄心力衰竭合并房颤抗凝治疗中的剂量优化研究[J]. 实用老年医学, 2022, 36(10): 1028-1032.

XU Yu-wen, LIU Qiong, SHEN Qiong, ZHU Yan, FANG Hong-jun. Dose optimization of rivaroxaban in anticoagulant therapy for elderly patients with heart failure complicated with atrial fibrillation[J]. Practical Geriatrics, 2022, 36(10): 1028-1032.

参考文献

[1] WESTERMAN S, WENGER N. Gender differences in atrial fibrillation: a review of epidemiology, management, and outcomes[J]. Curr Cardiol Rev, 2019, 15(2):136-144.
[2] MALE C, LENSING A W A, PALUMBO J S, et al. Rivaroxaban compared with standard anticoagulants for the treatment of acute venous thromboembolism in children: a randomised, controlled, phase 3 trial[J]. Lancet Haematol, 2020, 7(1):e18-e27.
[3] COHEN A T, BAUERSACHS R. Rivaroxaban and the EINSTEIN clinical trial programme[J]. Blood Coagul Fibrinolysis, 2019, 30(3):85-95.
[4] GUIMARES H P, LOPES R D, DE BARROS E SILVA P G M, et al. Rivaroxaban in patients with atrial fibrillation and a bioprosthetic mitral valve[J]. N Engl J Med, 2020, 383(22):2117-2126.
[5] COLEMAN C I, KREUTZ R, SOOD N A, et al. Rivaroxaban versus warfarin in patients with nonvalvular atrial fibrillation and severe kidney disease or undergoing hemodialysis[J]. Am J Med, 2019, 132(9):1078-1083.
[6] 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10):760-789.
[7] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等.心房颤动基层诊疗指南(2019年)[J]. 中华全科医师杂志, 2020, 19(6):465-473.
[8] 谢秀峰, 陈凤英.473例心房颤动患者复律前抗凝与血栓栓塞风险评估[J]. 内蒙古医科大学学报, 2020, 42(4):387-389, 397.
[9] 林小娟, 张进华.静脉血栓防治相关出血风险评估模型研究进展[J]. 中国实用外科杂志, 2019, 39(10):1111-1113.
[10] RICHTER S, DI BIASE L, HINDRICKS G. Atrial fibrillation ablation in heart failure[J]. Eur Heart J, 2019, 40(8):663-671.
[11] LAU D H, LINZ D, SANDERS P. New findings in atrial fibrillation mechanisms[J]. Card Electrophysiol Clin, 2019, 11(4):563-571.
[12] 李小龙, 赵力, 李田昌.心房颤动合并急性心肌梗死患者发生缺血性卒中危险因素分析[J]. 中国循证心血管医学杂志, 2019, 11(6):709-712.
[13] SAMAMA C M, LAPORTE S, ROSENCHER N, et al. Rivaroxaban or enoxaparin in nonmajor orthopedic surgery[J]. N Engl J Med, 2020, 382(20):1916-1925.
[14] COHEN O, LEVY-MENDELOVICH S, AGENO W. Rivaroxaban for the treatment of venous thromboembolism in pediatric patients[J]. Expert Rev Cardiovasc Ther, 2020, 18(11):733-741.
[15] 吴宣, 许雪清, 汪家淑, 等.不同剂量利伐沙班与华法林对高龄非瓣膜性心房颤动患者的抗凝治疗效果及安全性比较[J]. 中国当代医药, 2021, 28(3):90-94.
[16] 李茜, 严思敏, 葛卫红, 等.不同剂量利伐沙班对非瓣膜性房颤患者血栓栓塞与出血事件影响的研究[J]. 中南药学, 2021, 19(3):534-538.
[17] WYSOKINSKI W E, HOUGHTON D E, CASANEGRA A I, et al. Comparison of apixaban to rivaroxaban and enoxaparin in acute cancer-associated venous thromboembolism[J]. Am J Hematol, 2019, 94(11):1185-1192.
[18] 王葛, 赵力, 张博阳, 等.心功能对非瓣膜性心房颤动合并冠状动脉支架植入患者缺血性脑卒中及死亡风险的影响[J]. 中国全科医学, 2019, 22(10):1176-1181.
[19] KHORANA A A, SOFF G A, KAKKAR A K, et al. Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer[J]. N Engl J Med, 2019, 380(8):720-728.
[20] 王倩, 张丽, 黄俊, 等.利伐沙班在高龄非瓣膜性心房颤动患者中的常用剂量及预后分析[J]. 岭南心血管病杂志, 2019, 25(6):638-641.