2022 年第 8 期 第 17 卷

非瓣膜性心房颤动患者应用利伐沙班与达比加群酯长期抗凝治疗的有效性及安全性评价

Effectiveness and safety evaluation of long-term anticoagulant therapy with rivaroxaban and dabigatran etexilate on patients with non-valvular atrial fibrillation

作者：贾莉1刘思明1阚萌萌2孙力1于鲁海1

英文作者：Jia Li1 Liu Siming1 Kan Mengmeng2 Sun Li1 Yu Luhai1

单位：1新疆维吾尔自治区人民医院药学部，乌鲁木齐830001；2新疆维吾尔自治区伊犁哈萨克自治州奎屯医院药剂科，伊犁哈萨克自治州835000

英文单位：1Department of Pharmacy People′s Hospital of Xinjiang Uygur Autonomous Region，Urumqi 830001 China; 2Department of Pharmacy Kuitun Hospital of Ili Kazak Autonomous Prefecture Xinjiang Uygur Autonomous Region Ili Kazak Autonomous Prefecture 835000 China

关键词：心房颤动；利伐沙班；达比加群酯；抗凝治疗

英文关键词：Atrialfibrillation;Rivaroxaban;Dabigatranetexilate;Anticoagulanttherapy

• 摘要：

• 目的 比较长期应用利伐沙班与达比加群酯在非瓣膜性心房颤动（NVAF）患者抗凝治疗中的有效性及安全性。方法 入选2019年1月至2020年12月于新疆维吾尔自治区人民医院心房颤动中心就诊，服用利伐沙班或达比加群酯抗凝治疗的NVAF患者258例，根据口服不同抗凝药物分为利伐沙班组（92例）与达比加群酯组（166例）。随访12个月，比较2组患者栓塞事件与出血事件［血尿、黑便、其他部位出血（皮下出血、牙龈出血和鼻出血）］的发生率。结果 利伐沙班组出现脑梗死与心肌梗死各2例，栓塞事件发生率为4.3%（4/92）；达比加群酯组出现脑梗死2例、心肌梗死4例，栓塞事件发生率为3.6%（6/166）。2组栓塞事件发生率比较，差异无统计学意义（P=0.748）。利伐沙班组共发生出血事件14例（15.2%），均为其他部位出血；达比加群酯组共发生出血事件18例（10.8%），其中血尿4例（2.4%）、黑便2例（1.2%）、其他部位出血12例（7.2%）。2组患者总出血事件发生率比较，差异无统计学意义（P=0.307）。利伐沙班组其他部位出血发生率高于达比加群酯组，差异有统计学意义（P=0.041）。结论 利伐沙班和达比加群酯在NVAF人群中用于抗凝治疗安全有效，二者在出血事件和栓塞事件方面除其他部位出血外没有明显差异。

• Objective To evaluate the efficacy and safety of rivaroxaban and dabigatran etexilate on long-term  anticoagulation treatment in patients with non-valvular atrial fibrillation(NVAF). Methods Totally 258 patients with NVAF treated with rivaroxaban or dabigatran etexilate in Atrial Fibrillation Center, People′s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to December 2020 were selected. They were divided into rivaroxaban group (92 cases) and dabigatran etexilate group (166 cases) according to different oral anticoagulants. The patients were followed-up for 12 months to compare the incidence of embolic events and bleeding events ［hematuria, black stool, bleeding in other parts (subcutaneous bleeding, gum bleeding and epistaxis)］ between the two groups. Results There were 2 cases of cerebral infarction and 2 cases of myocardial infarction in rivaroxaban group, the incidence of embolic events as 4.3%(4/92); in the dabigatran etexilate group, there were 2 cases of cerebral infarction and 4 cases of myocardial infarction, the incidence of embolic events as 3.6%(6/166). There was no significant difference in the incidence of embolic events between the two groups (P=0.748). There were 14 cases (15.2%) of bleeding in other parts in rivaroxaban group; there were 18 bleeding events (10.8%) in the dabigatran etexilate group, including 4 cases (2.4%) of hematuria, 2 cases (1.2%) of black stool and 12 cases （7.2%）of bleeding in other parts. There was no significant difference in the incidence of total bleeding events between the two groups (P=0.307). The incidence of bleeding in other parts in rivaroxaban group was higher than that in dabigatran etexilate group (P=0.041). Conclusion Rivaroxaban and dabigatran etexilate are safe and effective in anticoagulant therapy in NVAF population, and there is no significant difference between them in bleeding events and embolic events except for bleeding in other parts.