作者：段靳岚，穆宁晖

单位：

650032 云南省昆明市，云南省第一人民医院 昆明理工大学附属医院全科医学科

Units：

Department of General Medicine, the First People's Hospital of Yunnan Province/Affiliated Hospital of Kunming University ofScience and Technology, Kunming 650032, China

关键词：

冠心病；心房颤动；老年人；抗凝药；利伐沙班；华法林

Keywords：

Coronary disease; Atrial fibrillation; Aged; Anticoagulants; Rivaroxaban; Warfarin

CLC：

R 541.4　R 541.75

DOI：

10.12114/j.issn.1008-5971.2021.00.145

Funds：

云南省科技厅科技计划项目（省基础研究计划）〔2019FE001（-295），2019FE001（-128）〕

摘要：

650032 云南省昆明市，云南省第一人民医院 昆明理工大学附属医院全科医学科

Abstract：

Background　The number of elderly patients with stable coronary heart disease and atrial fibrillation is increasing year by year. For this type of patients, anticoagulation therapy is required. The commonly used drug is warfarin in clinical practice, but long-term monitoring of adverse reactions is required during warfarin administration which has limited its clinical application. With the characteristics of stable anticoagulant effect and low bleeding risk, rivaroxaban has gradually attracted attention. Objective　To discuss the clinical efficacy and safety of a new oral anticoagulant drug rivaroxaban in the treatment of elderly patients with stable coronary heart disease and atrial fibrillation. Methods　A total of 100 elderly patients with stable coronary heart disease and atrial fibrillation who were hospitalized or outpatient in the Department of Geriatrics ofthe First People's Hospital of Yunnan Province in 2019 were selected as the research objects. According to the random number table method, the patients were divided into warfarin group and rivaroxaban group, each with 50 cases. The warfarin group was treated with warfarin sodium tablets on the basis of basic treatment, and the rivaroxaban group was treated with rivaroxaban tablets on the basis of basic treatment. The treatment time for all patients was 12 months. The general information, myocardial ischemia markers [including creatine kinase isoenzymes (CK-MB) , lactate dehydrogenase (LDH) , ischemia-modified albumin (IMA) ] and left ventricular diastolic function [including end-diastolic left ventricular posterior wall depth (LVPWD) , peak velocity in early diastole (E) and peak velocity in late diastole (A) ] before and after treatment, occurrence of cardiovascular and cerebrovascular events during treatment and safety indexes (occurrence of adverse reactions during treatment) of the two groups were compared. Results　After treatment, LDH and IMA in rivaroxaban group were lower than those in warfarin group (P 0.05) . The incidence of bleeding events during treatment in the rivaroxaban group was lower than that in the warfarin group (P 0.05) . Conclusion　Compared with warfarin, as a new type of oral anticoagulant, in the treatment of elderly patients with stable coronary heart disease and atrial fibrillation, rivaroxaban has a better anticoagulant effect, can more effectively reduce myocardial ischemia and protect the heart, which has a lower incidence of bleeding events and better safety.

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