CAJ | 학술논문

目的：观察高龄老年非瓣膜性心房纤颤（NVAF）患者应用小剂量达比加群酯抗凝治疗的疗效与安全性。方法纳入2013年11月至2014年4月住院高龄老年（年龄≥80岁）非瓣膜性房颤患者10例（既往未服用过口服抗凝药物），给予达比加群酯55 mg 2/日口服，观察患者服药后1个月和3个月的相关凝血功能指标及药物的安全性。结果与治疗前比较，达比加群酯治疗1个月和3个月时，患者凝血酶原时间（PT）、活化的部分凝血活酶时间（APTT）、凝血酶时间（TT）及血栓弹力图中的R值均逐渐延长，与治疗前比较均有统计学差异（P＜0.05）；国际标准化比值（INR）、D-二聚体及血栓弹力图中的K值、Angle角及MA值与治疗前比较无统计学差异（P＞0.05）；并且服药后3个月与1个月比较，患者PT、APTT及TT也具有统计学差异（P＜0.05）。10例患者服用达比加群酯后，未发生动脉血管栓塞事件，3例（30.0%）患者出现消化不良症状，1例（10.0%）患者发生皮下瘀斑，无明显出血、肝肾损害等不良事件发生。结论高龄老年非瓣膜性房颤患者应用小剂量达比加群酯进行抗凝治疗安全有效。但本研究属于小样本短期研究，今后需增加样本量及观察时间，进一步了解高龄老年小剂量达比加群酯进行抗凝治疗的疗效与安全性。
목적：관찰고령노년비판막성심방섬전（NVAF）환자응용소제량체비가군지항응치료적료효여안전성。방법납입2013년11월지2014년4월주원고령노년（년령≥80세）비판막성방전환자10례（기왕미복용과구복항응약물），급여체비가군지55 mg 2/일구복，관찰환자복약후1개월화3개월적상관응혈공능지표급약물적안전성。결과여치료전비교，체비가군지치료1개월화3개월시，환자응혈매원시간（PT）、활화적부분응혈활매시간（APTT）、응혈매시간（TT）급혈전탄력도중적R치균축점연장，여치료전비교균유통계학차이（P＜0.05）；국제표준화비치（INR）、D-이취체급혈전탄력도중적K치、Angle각급MA치여치료전비교무통계학차이（P＞0.05）；병차복약후3개월여1개월비교，환자PT、APTT급TT야구유통계학차이（P＜0.05）。10례환자복용체비가군지후，미발생동맥혈관전새사건，3례（30.0%）환자출현소화불량증상，1례（10.0%）환자발생피하어반，무명현출혈、간신손해등불량사건발생。결론고령노년비판막성방전환자응용소제량체비가군지진행항응치료안전유효。단본연구속우소양본단기연구，금후수증가양본량급관찰시간，진일보료해고령노년소제량체비가군지진행항응치료적료효여안전성。
Objective To observe the antithrombotic efficacy and safety of dabigatran etexilate in senile patients with nonvalvular atrial fibrillation (NVAF). Methods The senile patients (aged≥80, n=10) with nonvalvular AF (never taking oral antithrombotic drugs) were chosen from Nov. 2013 to Apr. 2014, and given oral dabigatran etexilate (55 mg) twice a day. The relative coagulation indexes and drug safety were observed after 1 m and 3 m. Results After treatment for 1 m and 3 m, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and R value in thrombelastogram (TEG) were prolonged gradually compared with those before treatment (P<0.05). International normalized ratio (INR), D-dimer, K value in TEG, Angle angle and MA value had no statistical difference after treatment (P>0.05). PT, APTT and TT had statistical difference after treatment for 3 m compare those after treatment for 1 m (P<0.05). In 10 patients, there was no one with artery thrombosis event, 3 (30.0%) with dyspeptic symptoms, and 1 (10.0%) with subcutaneous ecchymosis. There were no adverse events of bleeding and liver or kidney damage occurred. Conclusion Dabigatran etexilate in low dose is effective and safe for treating senile patients with nonvalvular AF. Because of small sample and short time in this study, bigger sample and longer observation time are needed to understand further the antithrombotic efficacy and safety of dabigatran etexilate in senile patients.