不同剂量利伐沙班对非瓣膜性房颤抗凝效果的影响

目的分析不同剂量利伐沙班对非瓣膜性房颤(NVAF)抗凝效果的影响。方法采用回顾性队列研究方法。收集医院心内科病区2017年3月至6月收治的201例接受利伐沙班抗凝治疗并拟行射频消融术的NVAF住院患者临床资料,采用单因素方差分析和多因素回归分析法评估不同剂量利伐沙班对NVAF患者的抗凝效果。结果患者的平均年龄OR=5.573,95%CI(2.621,8.525),P<0.001],年龄≥65岁比例OR=0.310,95%CI(0.162,0.594),P<0.001],预测肾小球滤过率(eGFR)水平(P=0.002),肾功能不全患者比例OR=0.273,95%CI(0.126,0.593),P=0.001],房颤血栓危险度(CHA₂DS₂-VASc)评分(P=0.025)与利伐沙班用量显著相关;合并冠心病OR=0.512,95%CI(0.280,0.937),P=0.029],联用阿司匹林OR=0.102,95%CI(0.029,0.356),P<0.001]、氯吡格雷OR=0.153,95%CI(0.055,0.423),P<0.001]、他汀类药物OR=0.467,95%CI(0.265,0.823),P=0.008]、胺碘酮OR=5.729,95%CI(2.106,15.586),P<0.001]、质子泵抑制剂OR=1.909,95%CI(1.088,3.351),P=0.024]等药物的低剂量组和高剂量组有显著差异。使用不同剂量利伐沙班后患者凝血功能指标均在正常范围内,无须监测。患者住院期间共23例(11.44%)发生出血,研究后发现,利伐沙班引起的出血风险与其日剂量显著相关OR=0.786,95%CI(0.637,0.970),P=0.025];此外,联用阿司匹林OR=7.700,95%CI(1.150,51.556),P=0.035]和出血风险评分升高OR=2.305,95%CI(1.044,5.091),P=0.039]可显著增加使用利伐沙班相关出血风险。结论利伐沙班日剂量、联用抗血小板药物和出血风险评分是导致NVAF患者出血的危险因素。

Effect of Different Doses of Rivaroxaban on Anticoagulation in Patients with Nonvalvular Atrial Fibrillation

Objective To analyze the effect of different doses of rivaroxabanon on anticoagulation in patients with nonvalvular atrial fibrillation(NVAF).Methods A retrospective cohort study was adopted.The clinical data of 201 patients with NVAF who received rivaroxaban anticoagulation therapy and planned to undergo radiofrequency ablation in the Department of Cardiology of our hospital from March to June 2017 were collected,and the anticoagulation effect of different doses of rivaroxaban on anticoagulation in patients with NVAF was evaluated by univariate analysis of variance and multivariate regression analysis.Results The average age of patientsOR=5.573,95%CI(2.621,8.525),P<0.001]and the proportion of patients with age≥65 years oldOR=0.310,95%CI(0.162,0.594),P<0.001],estimated glomerular filtration rate(eGFR,P=0.002),and the proportion of patients with renal insufficiencyOR=0.273,95%CI(0.126,0.593),P=0.001],CHA₂DS₂-VASc score(P=0.025)were significantly correlated with the dose of rivaroxaban.There were significant differences in patients with coronary heart diseaseOR=0.512,95%CI(0.280,0.937),P=0.029],the combination of aspirinOR=0.102,95%CI(0.029,0.356),P<0.001],clopidogrelOR=0.153,95%CI(0.055,0.423),P<0.001],statinsOR=0.467,95%CI(0.265,0.823),P=0.008],amiodaroneOR=5.729,95%CI(2.106,15.586),P<0.001],proton pump inhibitorsOR=1.909,95%CI(1.088,3.351),P=0.024]between low-dose group and high-dose group.After administration of different doses of rivaroxaban,the coagulation function indexes were in the normal range,which need not be detected.A total of 23 patients(11.44%)had bleeding during hospitalization,and the analysis result showed that the risk of rivaroxaban-induced bleeding was significantly correlated with its daily doseOR=0.786,95%CI(0.637,0.970),P=0.025].In addition,the combination of aspirinOR=7.700,95%CI(1.150,51.556),P=0.035]and increased HAS-BLED scoreOR=2.305,95%CI(1.044,5.091),P=0.039]could significantly increase the risk of rivaroxaban-induced bleeding.Conclusion Daily dose of rivaroxaban,the combination of antiplatelet drugs and HAS-BLED score are risk factors for bleeding in patients with NVAF.