新型抗凝药与华法林对非瓣膜性心房颤动患者抗凝效果的临床评价
作者:
作者单位:

(1.复旦大学附属华山医院静安分院心内科,上海市 200040;2.上海交通大学附属瑞金医院消化科,上海市 200025)

作者简介:

黄芳,住院医师,研究方向为心律失常,E-mail:761337469@qq.com。

基金项目:

国家自然科学基金资助项目(81970126)


Clinical evaluation of anticoagulation effect of new anticoagulants and warfarin in patients with non-valvular atrial fibrillation
Author:
Affiliation:

1.Department of Internal Medicine-Cardiovascular, Jing'an Branch of Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China;2.Digestive Department, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200025, China)

  • 摘要
  • | |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
    摘要:

    目的]研究利伐沙班、达比加群酯与华法林对非瓣膜性心房颤动抗凝效果。[方法]收集心内科接收的120例非瓣膜性心房颤动住院患者为研究对象,均服用单一抗凝药物,分为华法林组(40例)、利伐沙班组(40例)和达比加群酯组(40例),接受药物治疗6个月,比较治疗期间栓塞事件、出血事件发生率和血常规、肝肾功能及血栓弹力图指标情况。[结果]治疗6个月后,利伐沙班组和达比加群酯组栓塞事件发生率明显低于华法林组(P<0.05),而利伐沙班组与达比加群酯组比较差异无显著性(P>0.05);三组出血事件发生率、治疗前及治疗后6个月患者血常规指标(白细胞计数、血小板计数、血红蛋白)、肝肾功能指标(血清肌酐、谷丙转氨酶、血尿素氮)比较差异无显著性(P>0.05);治疗6个月后利伐沙班组与达比加群酯组血栓弹力图指标R值、K值、MA值均明显高于华法林组(P<0.05),但利伐沙班组与达比加群酯组比较差异无显著性(P>0.05)。[结论]利伐沙班、达比加群酯治疗非瓣膜性心房颤动相比华法林具有更优的抗凝效果,降低栓塞事件的发生,且对肝肾功能及血常规无明显影响,安全性高。

    Abstract:

    Aim To study the anticoagulant effect of rivaroxaban, dabigatran etexilate and warfarin in patients with non-valvular atrial fibrillation. Methods 120 patients with non-valvular atrial fibrillation who were admitted to our department of cardiology or outpatient clinic from January 2016 to January 2018 were enrolled in this study. All patients were treated with a single anticoagulant and divided into warfarin group (40 cases), rivaroxaban group (40 cases), dabigatran group (40 cases), receiving drug treatment for 6 months, and comparing embolization events, bleeding events, blood routine, liver and kidney function and thromboelastography indicators during treatment. Results After 6 months of treatment, the incidence of embolization events in the rivaroxaban group and dabigatran group was significantly lower than that in the warfarin group (P<0.05); There was no significant difference in the rivaroxaban group and dabigatran group (P>0.05). It can be seen that rivaroxaban and dabigatran etexilate are more helpful in preventing embolism. There were no significant differences in bleading incidence rate, blood routine parameters (white blood cell count, platelet count, hemoglobin) and liver and kidney function indexes (SCr, ALT, BUN) among the three groups at pre-treatment and 6 months after treatment (P>0.05). The R,Kü and MA values of thrombus elasticity index in rivaroxaban group and dabigatran group were significantly higher than those in warfarin group (P<0.05); There was no significant difference in R value,Kü value and MA value between the rivaroxaban group and the dabigatran group after 6 months (P>0.05). Conclusion Compared with warfarin, rivaroxaban and dabigatran etexilate have better anticoagulant effects in patients with non-valvular atrial fibrillation, which decrease embolization events but have no obvious effect on liver and kidney function and blood routine with high safety.

    参考文献
    [1] YANG Y M, SHAO X H, ZHU J, et al.One year outcomes of emergency department patients with atrial fibrillation:a prospective, multicenter registry in China.Angiology, 5,6(8):745-752.
    [2] DEITELZWEIG S, KESHISHIAN A, KANG A, et al.Use of non-vitamin K antagonist oral anticoagulants among patients with nonvalvular atrial fibrillation and multimorbidity.Adv Ther, 1,8(6):3166-3184.
    [3] WANG Y P, KEHAR R, IANSAVITCHENE A, et al.Bleeding risk in nonvalvular atrial fibrillation patients receiving direct oral anticoagulants and warfarin:a systematic review and Meta-analysis of observational studies.TH Open, 0,4(3):e145-e152.
    [4] XIONG Q M, LIP G Y.Selection of warfarin or one of the new oral antithrombotic agents for long-term prevention of stroke among persons with atrial fibrillation.Curr Treat Options Neurol, 5,7(2):331-335.
    [5] 中国康复医学会心血管病预防与康复专业委员会, 胡大一, 陈桂英, 等.心房颤动患者心脏康复中国专家共识.中华内科杂志, 1,0(2):106-116.CHINESE ASSOCIATION OF REHABILITATION MEDICINE CARDIOVASCULAR DISEASE PREVENTION AND REHABILITATION PROFESSIONAL COMMITTEE, HU D Y, CHEN G Y, et al.Chinese expert consensus on cardiac rehabilitation in patients with atrial fibrillation.Chin J Intern Med, 1,0(2):106-116.
    [6] PATEL M R, MAHAFFEY K W, GARG J, et al.Rivaroxaban versus warfarin in non-valvular atrial fibrillation.N Engl J Med, 1,5(10):2233-2235.
    [7] RUFF C T, GIULIANO R P, BRAUNWALD E, et al.Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation:a Meta-analysis of randomized trials.Lancet, 4,3(9921):955-962.
    [8] TEUNISSEN C, CLAPPERS N, HASSINK R J, et al.A decade of atrial fibrillation ablation.Neth Heart J, 7,5(10):559-566.
    [9] JANUARY C T, WANN L S, ALPERTL J S, et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society.J Am Coll Cardi, 4,4(21):e1-e76.
    [10] 黎欢, 杨俊龙, 谢佳, 等.肝硬化患者血栓弹力图与凝血指标的相关性分析.现代医药卫生, 2,8(7):1089-1093.LI H, YANG J L, XIE J, et al.Correlation analysis between thromboelastogram and coagulation indexes in patients with liver cirrhosis.J Mod Med Health, 2,8(7):1089-1093.
    [11] TSE H F, WANG Y J, AI-ABDULLAH M A, et al.Stroke prevention in atrial fibrillation-an Asian stroke perspective.Heart Rhythm, 3,0(7):1082-1088.
    [12] 谢秀峰, 李田昌, 袁海凤, 等.北京市高同型半胱氨酸血症伴低CHA2DS2-VASc非瓣膜性心房颤动PCI患者的预后分析.中国动脉硬化杂志, 0,8(7):594-598.XIE X F, LI T C, YUAN H F, et al.Prognosis of non-valvular atrial fibrillation patients after PCI with hyperhomocysteinemia and low CHA2DS2-VASc in Beijing.Chin J Arterioscler, 0,8(7):594-598.
    [13] MACLE L, CAIRNS J, LEBLANC K, et al.2016 focused update of the Canadian cardiovascular society guidelines for the management of atrial fibrillation.Can J Cardiol, 6,2(10):1170-1185.
    [14] WANG Z Z, DU X, WANG W, et al.Long-term persistence of newly initiated warfarin therapy in Chinese patients with non-valvular atrial fibrillation.Circ Cardiovasc Qual Outcomes, 6,9(4):380-387.
    [15] 陈月, 赵京玉, 鲁宛灵, 等.达比加群酯与华法林对非瓣膜性心房颤动患者抗凝效果及安全性的系统评价.中国临床药理学杂志, 6,2(21):2008-2011.CHEN Y, ZHAO J Y, LU W L, et al.A systematic review of anticoagulation efficacy and safety of dabigatran etexilate and warfarin in patients with non-valvular atrial fibrillation.Chin J Clin Pharmacol, 6,2(21):2008-2011.
    [16] KIRCHHOF P, BENISSI S, KOTECHA D, et al.2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS:the task force for the management of atriall fibrillation of the European society of cardiology.Eur J Cardiol Thoracic Surg, 6,0(5):1109-1116.
    [17] 吴玥, 冯静, 彭燕, 等.新型抗凝药与华法林用于非瓣膜性房颤患者卒中防治的成本效果分析.中国医院药学杂志, 6,6(12):1003-1007.WU Y, FENG J, PENG Y, et al.Cost-effectiveness analysis of new anticoagulants and warfarin for stroke prevention and treatment in patients with non-valvular atrial fibrillation.Chin J Hosp Pharm, 6,6(12):1003-1007.
    [18] JHUO S J, LO L W, CHANG S L, et al.Periesophageal vagal plexus injury is a favorable outcome predictor after catheter ablation of atrial fibrillation.Heart Rhythm, 6,3(9):1786-1793.
    [19] CICONTE G, OTTAVIANO L, DE A C, et al.Pulmonary vein isolation as index procedure for persistent atrial fibrillation:one-year clinical outcome after ablation using the second-generation cryoballoon.Heart Rhythm, 5,2(1):60-66.
    相似文献
    引证文献
引用本文

黄芳,王永康.新型抗凝药与华法林对非瓣膜性心房颤动患者抗凝效果的临床评价[J].中国动脉硬化杂志,2022,30(9):773~777.

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
历史
  • 收稿日期:2021-10-18
  • 最后修改日期:2022-01-23
  • 在线发布日期: 2022-07-30