利伐沙班用于HASBLED评分≥3分的高龄非瓣膜性心房颤动患者的有效性和安全性

doi:10.3969/j.issn.1004-583X.2024.02.004

摘要/Abstract

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。

关键词: 心房颤动, 高龄, HASBLED评分, 利伐沙班, 抗凝治疗

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.

Key words: atrial fibrillation, elderly, rivaroxaban, HASBLED score, anticoagulation therapy

中图分类号:

R541.75

王奕涵, 秦旭雁, 韩宣泽, 王樱洁, 高菲菲, 陈春红, 张岭楠, 张芳. 利伐沙班用于HASBLED评分≥3分的高龄非瓣膜性心房颤动患者的有效性和安全性[J]. 临床荟萃, 2024, 39(2): 121-124.

Wang Yihan, Qin Xuyan, Han Xuanze, Wang Yingjie, Gao Feifei, Chen Chunhong, Zhang Lingnan, Zhang Fang. Efficacy and safety of rivaroxaban therapy in elderly patients with non-valvular atrial fibrillation who had a HASBLED score≥3[J]. Clinical Focus, 2024, 39(2): 121-124.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.02.004

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I2/121

图/表 3

参考文献 19

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项目	低剂量组(n=40)	常规剂量组(n=50)	t/χ²值	P值
年龄(岁)	79.70±3.17	78.92±3.20	2.517	0.012
女性[例(%)]	18(45.0)	17(34.0)	0.750	0.386
体重指数(kg/m²)	24.50±3. 2	23. 89±2. 5	0. 027	0. 991
合并基础疾病[例(%)]
2型糖尿病	8(20.0)	20(40.0)	4.417	0.042
高血压	22(55.0)	30(60.0)	0.228	0.633
脑梗死或TIA	26(65.0)	26(52.0)	1.125	0.289
冠心病	12(30.0)	16(32.0)	0.112	0.738
心力衰竭	18(45.0)	28(56.0)	1.076	0.300
合并用药[例(%)]
阿司匹林	0	0	-	-
硫酸氢氯吡格雷	2(5.0)	0	0.773	0.379
他汀类药物	18(45.0)	26(52.0)	0.436	0.509
吲哚布芬	2(5.0)	0	0.773	0.379
肌酐清除率(ml/min)	82.08±28.54	88.72±21.49	0.283	0.595
CHA2DS2-VASc评分(中位数/四分位数)	6.0(3.0)	4.0(3.0)	2.470	0.014
HASBLED评分(中位数/四分位数)	3.0(2.0)	3.0(1.0)	2.076	0.038

项目	低剂量组(n=40)	常规剂量组(n=50)	t/χ²值	P值
年龄(岁)	79.70±3.17	78.92±3.20	2.517	0.012
女性[例(%)]	18(45.0)	17(34.0)	0.750	0.386
体重指数(kg/m²)	24.50±3. 2	23. 89±2. 5	0. 027	0. 991
合并基础疾病[例(%)]
2型糖尿病	8(20.0)	20(40.0)	4.417	0.042
高血压	22(55.0)	30(60.0)	0.228	0.633
脑梗死或TIA	26(65.0)	26(52.0)	1.125	0.289
冠心病	12(30.0)	16(32.0)	0.112	0.738
心力衰竭	18(45.0)	28(56.0)	1.076	0.300
合并用药[例(%)]
阿司匹林	0	0	-	-
硫酸氢氯吡格雷	2(5.0)	0	0.773	0.379
他汀类药物	18(45.0)	26(52.0)	0.436	0.509
吲哚布芬	2(5.0)	0	0.773	0.379
肌酐清除率(ml/min)	82.08±28.54	88.72±21.49	0.283	0.595
CHA2DS2-VASc评分(中位数/四分位数)	6.0(3.0)	4.0(3.0)	2.470	0.014
HASBLED评分(中位数/四分位数)	3.0(2.0)	3.0(1.0)	2.076	0.038

组别	例数	PT(s)	APTT(s)	FIB(g/L)	TT(s)
低剂量组	40	12.85(3.0)	33.65(7.0)	3.40±0.73	15.30(2.0)
常规剂量组	50	13.90(3.0)	33.20(6.0)	3.13±0.59	15.00(2.0)
t/Z值		1.154	0.650	1.946	0.244
P值		0.249	0.516	0.055	0.807

组别	例数	PT(s)	APTT(s)	FIB(g/L)	TT(s)
低剂量组	40	12.85(3.0)	33.65(7.0)	3.40±0.73	15.30(2.0)
常规剂量组	50	13.90(3.0)	33.20(6.0)	3.13±0.59	15.00(2.0)
t/Z值		1.154	0.650	1.946	0.244
P值		0.249	0.516	0.055	0.807

组别	例数	缺血性脑卒中	外周血管栓塞	脑出血	消化道出血	牙龈出血	皮下瘀斑	血尿	便潜血阳性
低剂量组	40	0	0	0	0	0	0	0	0
常规剂量组	50	0	0	0	0	2(4.0)	3(6.0)	0	3(6.0)
χ²值		-	-	-	-	0.808	0.808	-	0.294
P值		-	-	-	-	0.369	0.369	-	0.587