摘要
目的:分析非瓣膜性房颤患者服用达比加群发生出血的危险因素。方法:本研究是一个单中心、回顾性研究,旨在探索达比加群相关出血事件的危险因素。应用某院电子病历管理系统,收集于2014年11月-2016年7月期间517例接受达比加群抗凝治疗的非瓣膜性房颤患者资料,包括患者年龄、性别、体质量、血常规、血脂、血糖、肝肾功能、合并疾病以及治疗药物等。结果:所有纳入研究的患者住院期间共有49例(9.5%)发生了出血,468例(90.5%)未发生出血。2组患者在性别、体质量、用药前红细胞压积、血小板计数、肝功能、血脂、空腹血糖、凝血指标以及合并高血脂症、肝功能不全和心功能不全方面的差异无显著性。然而,出血事件往往倾向发生于老年以及合并高血压和糖尿病的患者。肾功能不全是导致达比加群出血的重要危险因素之一,其中肌酐>115μmol·L^(-1)、估测肾小球滤过率<60mL/(min·1.73m^2)会显著增加房颤患者服用达比加群发生出血不良反应的风险。此外,联合应用抗血小板药物可增加房颤患者服用达比加群的出血风险,当联合应用双联抗血小板药物时出血风险显著升高(OR=4.16,95%CI 2.07~8.37)。结论:非瓣膜性房颤患者使用达比加群发生出血事件的危险因素有高龄,合并高血压、糖尿病,肌酐>115μmol·L^(-1),肾小球滤过率<60mL/(min·1.73m^2)以及联合应用抗血小板药物。
OBJECTIVE To identify clinical risk factors associated with hemorrahge among patients with nonvalvular atrial fibrillation who initiated dabigatran therapy.METHODS The purpose of this single center retrospective study was to estimate the risk factors of hemorrhage among patients receiving dabigatran.In our study,517 patients with nonvalvular atrial fibrillation initiating dabigatran therapy were enrolled from November 2014 to July 2016.The baseline characteristics,biochemical indicators,comorbidities and concomitant medications were recorded through the electronic medical record system of our hospital.RESULTS Among all the patients,49（9.5%）cases experienced hemorrhage.Between the hemorrhage group and the non-hemorrhage group,no statistically significant difference was found in sex,weight,hemoglobin level,hematocrit,platelet count,liver function,blood fat,fasting blood glucose,coagulation indexes before treatment,hyperlipidemia,hepatic insufficiency and heart failure.Patients who suffered hemorrhage tended to be with increased age,hypertension and diabetes mellitus.Renal dysfunction was an important risk factor associated with hemorrhage during dabigatran therapy,along with creatinine115μmol·L^（-1） and glomerular filtration rate60 mL/（min·1.73 m^2）significantly increased the risk of hemorrhage among patients with atrial fibrillation receiving dabigatran.In addition,the study found that concomitant antithrombotic agents highly increased the hemorrhage rates in patients with atrial fibrillation,and that combined use of dual antiplatelet drugs was associated with higher risk of hemorrhage（OR=4.166,95% CI 2.07-8.37）.CONCLUSION Increasing age,hypertension,diabetes,creatinine115μmol·L^（-1）,glomerular filtration rate60 mL/（min·1.73 m^2）,and concomitant antiplatelet drugs are potential risk factors of hemorrhage among patients with nonvalvular atrial fibrillation receiving dabigatran therapy.
作者
李晓烨
计秋旖
沈赟
LI Xiao-ye;JI Qiu-yi;SHEN Yun(The Department of Pharmacy, Zhongshan Hospital, Shanghai 200032, Chin)
出处
《中国医院药学杂志》
CAS
北大核心
2018年第6期645-649,共5页
Chinese Journal of Hospital Pharmacy
关键词
非瓣膜性房颤
达比加群
出血
危险因素
nonvalvular atrial fibrillation
dabigatran
hemorrhage
risk factor
