Song Zi-Kai, Cao Hongyan, Wu Haidi, Wei Qi, Tang Minglong, Yang Shuo, Liu Yang, Qin Ling
Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China.
Exp Ther Med. 2020 Apr;19(4):2817-2825. doi: 10.3892/etm.2020.8559. Epub 2020 Feb 26.
Acute pulmonary embolism (PE) occurs with a high incidence rate in elderly patients, demonstrating complex clinical manifestations, as well as a difficult anticoagulant treatment strategy. Currently, there is limited understanding of the selection criteria for anticoagulant treatment in elderly patients with PE. In fact, the vitamin K antagonist warfarin, a commonly prescribed anticoagulant, has multiple disadvantages, including a narrow therapeutic range, unpredictable pharmacokinetics, multiple food and drug interactions and genetic polymorphisms resulting in poor response to this therapy; therefore, routine laboratory monitoring is required. Most elderly patients with PE fail to adhere to the treatment regimen or even discontinue it, and clinicians are equally hesitant to initiate oral anticoagulants in elderly patients with PE. This leads to a dilemma regarding the use of anticoagulation therapies and a worse prognosis for the patients. Rivaroxaban, a direct Xa factor inhibitor, has demonstrated considerable practical and clinical advantages, exhibits fast-start action pharmacokinetic and pharmacodynamic characteristics, and has an enhanced predictable anticoagulant effect with fewer drug-drug interactions. Based on randomized controlled trials and real-world clinical practice, rivaroxaban has also been recognized as a safe and effective anticoagulant, and these advantages have improved the therapeutic compliance of elderly patients with PE. Thus, this review focused on the current status of rivaroxaban treatment for elderly patients with PE, and described its significance in changing the current anticoagulation treatment regimens for patients. It is expected that rivaroxaban will become a good choice for the treatment of PE in elderly patients.
急性肺栓塞（PE）在老年患者中发病率较高，临床表现复杂，抗凝治疗策略也较为棘手。目前，对于老年PE患者抗凝治疗的选择标准了解有限。事实上，常用的抗凝药物维生素K拮抗剂华法林存在诸多缺点，包括治疗窗窄、药代动力学不可预测、食物和药物相互作用多以及基因多态性导致治疗反应不佳；因此，需要进行常规实验室监测。大多数老年PE患者无法坚持治疗方案，甚至中断治疗，临床医生在老年PE患者中启动口服抗凝药时也同样犹豫不决。这导致了抗凝治疗使用方面的困境以及患者预后较差。利伐沙班是一种直接Xa因子抑制剂，已显示出相当大的实际和临床优势，具有快速起效的药代动力学和药效学特征，抗凝效果可预测性增强，药物相互作用较少。基于随机对照试验和真实世界临床实践，利伐沙班也被认为是一种安全有效的抗凝药物，这些优势提高了老年PE患者的治疗依从性。因此，本综述聚焦于利伐沙班治疗老年PE患者的现状，并阐述其在改变患者当前抗凝治疗方案方面的意义。预计利伐沙班将成为老年PE患者治疗的良好选择。
