摘要
目的分析单中心老年心房颤动(房颤)患者的抗凝防治现状,并评价口服抗凝药的疗效和安全性。方法连续收集2018年1月~2020年12月解放军总医院住院的老年房颤患者4239例,详细记录患者病历资料,总结不同抗凝方案的应用现状,最终纳入随访患者1647例,中位随访时间23.5个月,最长随访时间36.4个月。根据在院抗凝方案不同分为华法林组436例,达比加群组348例,利伐沙班组410例,未抗凝组453例。记录终点事件发生。结果利伐沙班组年龄、男性、硝酸酯类、CHA;DS;-VASc评分≥2分比例较其他3组更高,华法林组应用止血药物比例较其他3组更高,有统计学差异(P<0.05)。多因素Cox回归分析显示,华法林组发生出血事件风险较未抗凝组明显增加,利伐沙班组发生缺血事件风险较未抗凝组明显降低,华法林组发生全因死亡风险较未抗凝组明显降低(P<0.05)。达比加群组和利伐沙班组发生出血事件风险较华法林组明显降低(HR=0.49,95%CI:0.29~0.81,P=0.01;HR=0.52,95%CI:0.32~0.87,P=0.01),达比加群组发生缺血事件风险较华法林组明显增加(HR=2.17,95%CI:1.15~4.12,P=0.02),利伐沙班组发生缺血事件风险较达比加群组明显降低(HR=0.29,95%CI:0.14~0.62,P=0.01)。结论老年房颤患者临床现状仍不理想,需要加强抗凝宣教和普及;利伐沙班安全性和有效性可能优于其他口服抗凝方案,对需要长期抗凝预防脑卒中的老年房颤患者建议首选利伐沙班。
Objective To evaluate the therapeutic effectiveness and safety of oral anticoagulants in elderly AF patients in a single center.Methods A total of 4239 elderly AF patients admitted to our hospital from January 2018 to December 2020 were included in this study.Their medical records data were recorded, and the status quo of different anticoagulant therapies was summarized.A total of 1647 elderly AF patients were followed up for 23.5 months, and the longest follow-up time was 36.4 months.The 1647 followed up elderly AF patients were divided into warfarin treatment group(n=436),dabigatran treatment group(n=348),rivaroxaban treatment group(n=410) and non-anticoagulant treatment group(n=453).The end events were recorded.Results The age was significantly older, the number of male AF patients was significantly greater, the serum nitrate level and CHA;DS;-VASc score≥2 were significantly higher in rivaroxaban treatment group than in warfarin treatment group, dabigatran treatment group and non-anticoagulant treatment group while the ratio of used hemostatic drugs was significantly higher in warfarin treatment group than in dabigatran treatment group, rivaroxaban treatment group and non-anticoagulant treatment group(P<0.05).Multivariate Cox regression analysis showed that the risk of bleeding was significantly higher in warfarin treatment group than in non-anticoagulant group while the risk of ischemia was significantly lower in rivaroxaban treatment group than in non-anticoagulant treatment group, the risk of all-cause deaths was significantly lower in warfarin treatment group than in non-anticoagulant treatment group(P<0.05) and the risk of bleeding was significantly lower in dabigatran treatment group, rivaroxaban treatment group than in warfarin treatment group(HR=0.49,95%CI:0.29-0.81,P=0.01;HR=0.52,95%CI:0.32-0.87,P=0.01) while the risk of ischemia was significantly higher in rivaroxaban treatment group than in warfarin treatment group(HR=2.17,95%CI:1.15-4.12,P=0.02) and significantly lower in rivaroxaban treatment gr
作者
马宇飞
于焱
洛佳坤
卢若谷
孙沙沙
黄鑫
管博
杨明艳
曹剑
Ma Yufei;Yu Yan;Luo Jiakun;Lu Ruogu;Sun Shasha;Huang Xin;Guan Bo;Yang Mingyan;Cao Jian(Department of Cardiology,Chinese PLA General Hospital No.2 Medical Center,Beijing 100853,China)
出处
《中华老年心脑血管病杂志》
北大核心
2022年第4期380-384,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
军队保健专项科研课题(21BJZ26)
国家老年疾病临床医学研究中心项目(ZXD2006)。
关键词
心房颤动
抗凝药
华法林
达比加群
利伐沙班
atrial fibrillation
anticoagulants
warfarin
dabigatran
rivaroxaban
