【摘要】 目的 前瞻性探讨高龄HASBLED≥3分的非瓣膜性心房颤动(atrial fibrillation, AF)患者应用利伐沙班抗凝治疗的有效性和安全性。方法 收集2023年2-9月住院的75岁以上使用利伐沙班抗凝治疗的非瓣膜性AF患者(HASBLED评分≥3分)90例，分为低剂量组(10 mg/d),常规剂量组(15 mg/d)。随访6个月，有效终点事件：缺血性脑卒中、外周动脉栓塞，安全终点事件：大出血和临床有意义的小出血，小出血包括皮下淤血、牙龈出血、血尿、便潜血阳性、眼结膜出血。结果 (1)低剂量组CHA2DS2-VASc评分和HASBLED评分均高于常规剂量组，差异有统计学意义(P<0.05)。(2)两组治疗前凝血指标比较差异无统计学意义(P>0.05)。(3)随访6个月，两组均未见到新发缺血性脑卒中、外周栓塞事件。常规剂量组便潜血阳性3例，牙龈出血2例，皮下瘀斑3例。结论 高龄HASBLED≥3分的非瓣膜性AF患者应用低剂量利伐沙班抗凝治疗有效、安全。更多还原

【Abstract】 Objective The aim of this study was to prospectively evaluate the efficacy and safety of rivaroxaban in the treatment of elderly patients with non-valvular atrial fibrillation(NVAF) who had a HASBLED score≥3.Methods A total of 90 patients over 75 years old with NVAF(HASBLED score≥3) treated with rivaroxaban from February to September in 2023, they were divided into low dose group(10 mg/d) and conventional dose group(15 mg/d). A 6-month follow-up was performed, the end points of primary efficacy were ischemic stroke, peripheral arterial embolism. The major bleeding was as a safety end point, including clinically significant minor bleeding, small bleeding as subcutaneous congestion, gingival bleeding, hematuria, occult blood positive stool, conjunctival bleeding. Results The scores of CHA2DS2-VASc and HASBLED in low dose group were significantly higher than those in conventional dose group(P<0.05). There was no significant difference in coagulation index between the two groups before treatment(P>0.05). During the 6-month follow-up, no new ischemic stroke and peripheral embolic events were observed in the low dose group and conventional dose group. There were 3 cases of occult blood positive stool, 2 cases of gingival bleeding and 3 cases of subcutaneous ecchymosis in conventional dose group. Conclusion Low-dose rivaroxaban anticoagulation therapy is effective and safety in elderly NVAF patients who HASBLED score ≥3, which provides theoretical basis for clinical application.更多还原