Effect observation on elderly patients with non-valvular atrial fibrillation treated with dabigatran etexilate
Objective To investigate the effects of dabigatran etexilate treatment on the coagulation function,cardiac function,adverse reactions,and prognosis in elderly patients with non-valvular atrial fibrillation.Methods This study was a randomized controlled trial.A total of 130 elderly patients with non-valvular atrial fibrillation admitted to the Second Hospital of Tianjin Medical University from January 2020 to September 2023 were included.The patients were divided into group A(warfarin treatment,43 cases),group B(rivaroxaban treatment,43 cases),and group C(dabigatran etexilate treatment,44 cases)by the random number table method.Group A included 22 males and 21 females,aged(74.56±6.43)years;there were 23 cases of grade Ⅰ and 20 cases of gradeⅡ cardiac function.Group B included 24 males and 19 females,aged(73.89±6.21)years;there were 22 cases of grade Ⅰ and 21 cases of grade Ⅱ cardiac function.Group C included 20 males and 24 females,aged(74.12±6.38)years;there were 23 cases of grade Ⅰ and 21 cases of grade Ⅱ cardiac function.Group A was treated with warfarin sodium tablets,once a day,starting at 2.5 mg and then adjusting the dose according to the international normalized ratio(INR)by 0.5 mg each time,keeping the INR between 2.0 and 3.0.Group B was treated with rivaroxaban tablets,15 mg each time,once a day.Group C was treated with dabigatran etexilate capsules,110 mg each time,twice a day.The course of treatment was 2 months.The levels of liver and kidney function indicators[creatinine(Cr),urea nitrogen(BUN),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)],coagulation function indicators[thrombin time(TT),fibrinogen(FIB),activated partial thromboplastin time(APTT),and plasma prothrombin time(PT)],CHA2DS2-VASc scores of atrial fibrillation thromboembolic risk,HAS-BLED scores of atrial fibrillation anticoagulant bleeding risk,and adverse reactions(skin ecchymosis,nausea and vomiting,stroke,and hematuria)of the three groups were compared.The patients were followed up for 3 months to record the incidences of thromboembolic formation and bleeding.Repeated measure AN OVA,x2 test,and Fisher exact probability method were used.Results After 2 months of treatment,the levels of Cr,BUN,ALT,and AST in group B and C were lower than those in group A,with statistically significant differences(all P＜0.05).The levels of TT,APTT,and PT in group B and C were higher than those in group A,and the levels of FIB in group B and C were lower than that in group A,with statistically significant differences(all P＜0.05).The CHA2DS2-VASc and HAS-BLED scores in group A,B,and C after treatment were slightly higher than those before treatment,but the differences were not statistically significant(all P＞0.05).The incidences of adverse reactions in group A,B,and C were 16.28％(7/43),4.65％(2/43),and 2.27％(1/44);the incidence of adverse reactions in group C was lower than that in group A,with a statistically significant difference(P＜0.05).After 3 months of follow-up,the rates of thromboembolic formation and minor bleeding in group B and C were slightly lower than those in group A,but the differences were not statistically significant(all P＞0.05).Conclusion In treating elderly patients with non-valvular atrial fibrillation,dabigatran etexilate and rivaroxaban demonstrate better therapeutic effects and safety compared to warfarin,improving the liver and kidney functions and coagulation function,and reducing the adverse reactions and thromboembolic and bleeding events.
万方数据
维普
