Department of Pharmacy, Anji People's Hospital, Huzhou City, Zhejiang, Province 313300, China.
Biomed Res Int. 2022 Jul 7;2022:4611383. doi: 10.1155/2022/4611383. eCollection 2022.
To observe the safety and efficacy of warfarin and rivaroxaban in anticoagulation therapy in patients with atrial fibrillation (AF).
A total of 96 patients with AF treated in our hospital from June 2019 to February 2021 were enrolled in this study. According to the different modes of drug administration, the patients were divided into the warfarin group and rivaroxaban group. Demographic and clinical data such as age, body weight, and previous drug use were collected. The blood routine, liver and kidney function, blood coagulation routine, and cardiac color ultrasound were accessed. The valvular atrial fibrillation and anticoagulant taboos were excluded, and the risk of embolism and bleeding was evaluated. Among them, 48 patients in the warfarin group were given warfarin once a day, and the international ratio (INR) was used to adjust the dose, and the INR was controlled between 2.0 and 3.0. In contrast, 48 patients in the rivaroxaban group received a fixed dose of rivaroxaban 20 mg or 15 mg once a day. After administration, regular telephone or outpatient follow-up was given once a month, to monitor patients' drug compliance and ask if there was bleeding, and to detect blood routine, urine routine, fecal routine+occult blood, and liver and kidney function. In addition, at the beginning of 3, 6, and 12 months of follow-up, each patient was given cardiac color Doppler ultrasound, peripheral vascular color ultrasound, and brain CT to determine whether there were mural thrombosis, stroke, and peripheral arterial thromboembolism. The INR attainment rate, coagulation index, thromboembolism, bleeding, and adverse reactions were compared between the two groups.
There was no significant difference in serum Dmurd and NT-proBNP levels between the two groups before treatment and 3, 6, and 9 months after treatment. There was no significant difference in the number of venous embolism, pulmonary embolism, cerebral embolism, and total embolism between the two groups ( > 0.05). There was no significant difference in the number of mild, moderate, and severe bleeding between the two groups ( > 0.05), but the total number of bleeding in the rivaroxaban group was lower than that in the warfarin group ( < 0.05). During the treatment, side effects such as nausea and vomiting, elevated transaminase, glutamyl transpeptidase, and diarrhea occurred between the two groups, and there was no significant difference in the number of adverse reactions between the two groups ( > 0.05).
Compared with warfarin, rivaroxaban anticoagulant therapy has the same advantage in tolerance and prevention of thromboembolism in patients with AF, but rivaroxaban can effectively reduce the risk of bleeding in patients with AF.
观察华法林和利伐沙班在心房颤动（AF）患者抗凝治疗中的安全性和有效性。
选取 2019 年 6 月至 2021 年 2 月我院收治的 96 例 AF 患者作为研究对象，根据药物给药方式的不同将患者分为华法林组和利伐沙班组。收集两组患者的年龄、体重、既往用药等一般资料。检测血常规、肝肾功能、凝血常规、心脏彩色超声，排除瓣膜性心房颤动和抗凝禁忌证，评估栓塞和出血风险。其中华法林组 48 例患者给予华法林 1 次/d，根据国际标准化比值（INR）调整剂量，控制 INR 在 2.0~3.0 之间；利伐沙班组 48 例患者给予利伐沙班 20、15 mg 1 次/d 固定剂量。给药后，每月进行 1 次电话或门诊随访，监测患者的药物依从性，询问有无出血情况，并检测血常规、尿常规、粪便常规+隐血、肝肾功能。此外，在随访开始后 3、6、12 个月时，每组患者均进行心脏彩色多普勒超声、外周血管彩色超声和脑 CT 检查，以确定是否存在壁血栓、卒中、外周动脉血栓栓塞。比较两组患者 INR 达标率、凝血指标、血栓栓塞、出血及不良反应发生情况。
两组患者治疗前及治疗后 3、6、9 个月的血清 Dmurd、NT-proBNP 水平比较，差异无统计学意义（ > 0.05）；两组患者静脉栓塞、肺栓塞、脑栓塞及总栓塞例数比较，差异无统计学意义（ > 0.05）；两组患者轻度、中度、重度出血例数比较，差异无统计学意义（ > 0.05），但利伐沙班组出血总例数低于华法林组（ < 0.05）；治疗期间两组患者均出现恶心呕吐、转氨酶升高、谷氨酰转肽酶升高、腹泻等不良反应，两组不良反应发生例数比较，差异无统计学意义（ > 0.05）。
与华法林相比，利伐沙班抗凝治疗在 AF 患者的耐受性和预防血栓栓塞方面具有相同的优势，但利伐沙班可有效降低 AF 患者出血风险。
