Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Clin Appl Thromb Hemost. 2018 Dec;24(9_suppl):188S-193S. doi: 10.1177/1076029618800830. Epub 2018 Sep 24.
Rivaroxaban, a direct factor Xa inhibitor, is widely used to reduce the chance of stroke in patients with atrial fibrillation (AF). It is not clear why the prothrombin time (PT) of the international normalized ratio (INR) fails to correlate with treatment using rivaroxaban in patients with AF. In this study, patient characteristics, the rivaroxaban dosage, AF type, drug history, biochemical properties, and hematological profiles were assessed in patients treated with rivaroxaban. In 69 patients with AF receiving rivaroxaban, 27 (39.1%) patients had a normal INR (≤1.1, group 1), 27 (39.1%) patients had a slightly prolonged INR (1.1∼1.5, group 2), and 15 (21.7%) patients had a significantly prolonged INR (>1.5, group 3). Group 1 patients had a higher incidence of a stroke history than did patients in group 2 ( = .026) and group 3 ( = .032). We scored patients with a persistent AF pattern (1 point), paroxysmal AF pattern (0 point), renal function (ie, the creatinine clearance rate in mL/min/1.73 m of >60 as 0 points, of 30∼60 as 1 point, and of <30 as 2 points), and no history of stroke (1 point), and we found that group 3 had a higher score than groups 2 or 1 (2.9 ± 0.8, 2.4 ± 0.7, and 2 ± 0.7, respectively; < .05). There were similar incidences of bleeding, stroke, and unexpected hospitalizations among the 3 groups. The PT of the INR is determined by multiple variables in patients with AF receiving rivaroxaban. Rivaroxaban-treated patients with AF having different INR values may have similar clinical outcomes.
利伐沙班是一种直接的 Xa 因子抑制剂，广泛用于降低房颤（AF）患者中风的风险。目前尚不清楚为什么在接受利伐沙班治疗的 AF 患者中，国际标准化比值（INR）的凝血酶原时间（PT）与治疗效果无法相关。在这项研究中，评估了接受利伐沙班治疗的患者的患者特征、利伐沙班剂量、AF 类型、药物史、生化特性和血液学特征。在 69 例接受利伐沙班治疗的 AF 患者中，27 例（39.1%）患者的 INR 正常（≤1.1，组 1），27 例（39.1%）患者的 INR 略有延长（1.1∼1.5，组 2），15 例（21.7%）患者的 INR 显著延长（>1.5，组 3）。与组 2（=.026）和组 3（=.032）相比，组 1 患者的中风病史发生率更高。我们对持续性 AF 模式（1 分）、阵发性 AF 模式（0 分）、肾功能（即，肌酐清除率以 mL/min/1.73 m 计＞60 为 0 分，30∼60 为 1 分，＜30 为 2 分）和无中风病史（1 分）进行评分，结果发现组 3 的评分高于组 2 和组 1（分别为 2.9 ± 0.8、2.4 ± 0.7 和 2 ± 0.7；<.05）。三组患者的出血、中风和意外住院发生率相似。接受利伐沙班治疗的 AF 患者的 INR 的 PT 由多个变量决定。接受利伐沙班治疗的 INR 值不同的 AF 患者可能具有相似的临床结局。
