【摘要】 目的了解80岁以上非瓣膜性心房颤动(房颤)患者利伐沙班常用剂量、影响因素、疗效及安全性。方法回顾性分析115例80岁以上于2014年5月至2017年8月在广东省人民医院住院,并应用利伐沙班的非瓣膜性房颤患者的临床资料,门诊或电话随访临床结局。依据患者初始用药剂量分为低剂量组(0～10 mg/d)14例(12.17%),中剂量组(=10 mg/d)85例(73.91%)和高剂量组(10～20 mg/d)16例(13.91%),并进行组间比较。结果随着利伐沙班剂量增加,合并应用抗血小板药物减少,3组间比较差异具有统计学意义(P<0.05)。随访1年发现:3组患者在全因死亡和小出血事件方面比较,差异具有统计学意义(P<0.05),其中中剂量组患者全因死亡和小出血事件发生率最低;进一步组间分析发现这种差异主要存在于中剂量组和低剂量组之间(P=0.029)。3组脑卒中、外周栓塞、心肌梗死和大出血患者比例比较,差异均无统计学意义(P>0.05)。结论在高龄非瓣膜性房颤患者中,利伐沙班的常用剂量为10 mg/d;影响其应用剂量的因素为合并应用抗血小板药物;在总体疗效和安全性方面,利伐沙班10 mg/d可能是高龄非瓣膜性房颤患者最佳使用剂量。更多还原

【Abstract】 Objectives To investigate usual dose,influence factors,efficacy and safety of nonvalvular atrial fibrillation patients aged 80 and above treated with rivaroxiban. Methods Clinical datas of 115 hospitalized patients aged 80 and above with nonvalvular atrial fibrillation and had been treated with rivaroxiban from May 2014 to August 2017 in Guangdong Provincial People′s Hospital were collected and retrospectively analyzed,and their clinical outcomes were followed up by outpatient or telephone. Patients were divided into low-dose group(0-10 mg/d,n=14),medium-dose group(=10 mg/d,n=85)and high-dose group(10-20 mg/d,n=16)according to the initial dose. Results With rivaroxaban dose increasing,percentage of patients combined antiplatelet drugs decreasing,differences among the three groups were statistically significant(P<0.05). After 1 year follow-up,it was found that there were statistically significant differences in all-cause death and minor bleeding events among the three groups(P<0.05),and middle-dose group had the lowest incidence of all-cause death and minor bleeding events. Further inter-group analysis revealed that this difference was mainly found between medium-dose and low-dose group(P=0.029). There was no significant difference among the three groups in terms of stroke,peripheral embolism,myocardial infarction and massive hemorrhage(P>0.05).Conclusions In octogenarians with nonvalvular atrial fibrillation,the usual dose of rivaroxaban is 10 mg/d. The factors influencing the dose were the combination of antiplatelet drugs. In terms of overall efficacy and safety,rivaroxaban at 10 mg/d may be the optimal dose for octogenarians with nonvalvular atrial fibrillation.更多还原