凝血指标在服用达比加群酯的老年非瓣膜性心房颤动患者抗凝监测中的应用

Application of Coagulation Indexes in Monitoring Coagulation Effect of Dabigatran Etexilate in the Elderly with NVAF

中文关键词: 达比加群酯  心房颤动  凝血功能

英文关键词: dabigatran extexilate  atrial fibrillation  coagulation function

中文摘要:

      目的 通过常规凝血指标来监测达比加群酯的抗凝程度,从而指导药物剂量的调整.方法 选择从2014年1月-2016年12月在复旦大学附属华东医院就诊的老年非瓣膜性房颤(NVAF)患者56例,其中男性36例,女性20例,平均年龄(78.0±6.6)岁,口服达比加群酯110mg,2次/日,监测服药前后凝血功能.结果 (1)患者服药后凝血指标凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、帆浆凝血酶时间(TT)较服药前延长,差异有统计学意义(P=0.000),纤维蛋白原(FIB)差异无统计学意义;(2)服药后TT明显延长组(TT≥ 200 s)与TT轻度延长组(TT＜ 200 s)比较,2组间服药前后PT、INR、FIB变化值无差异,TT明显延长组服药前后APTT的变化值大于TT轻度延长组,差异有统计学意义(P=0.002);(3)服用达比加群酯后APTT是服药前(1.47±0.40)倍,小于指南推荐的APTT正常范围高值的2倍(本研究中心APTT正常参考范围为28～45 s).结论 APTT可作为评估达比加群酯抗凝强度及调整药物剂量的参考指标.

英文摘要:

      Objective To assess the coagulation effect of dabigatran etexilate with the application of routine coagulation indexes so as to provide reference for drug dosage adjustment.Methods 56 elderly with nonvalvular atrial fibrillation (NVAF) receiving treatment in Huadong Hospital during the period from Jan.,2014 to Dec.,2016 were selected,36 males and 20 females with the average age of (78.0±6.6) years old;oral administration of dabigatran etexilate,110 mg,twice a day,was made to all the cases and coagulation function before and after drug taking was monitored.Results The prothrombin time (PT),international normalized ratio (INR),activated partial thromboplastin time (APTT) and plasma thrombin time (TT) after drug taking were longer than those before drug taking,the difference was of statistical significance (P=0.000)while there existed no statistical difference in fibrinogen (FIB);no statistical differences were found in the changes of PT,INR and FIB before and after drug taking between the cases with obvious prolonged TT (TT ≥ 200 s) and the cases with slight prolonged TT (TT ＜200 s) after drug taking while the change of APTT before and after drug taking in cases with obviously prolonged TT was bigger than that in cases with slightly prolonged TT,the difference was of statistical significance (P=0.002);APTT after taking dabigatran etexilate was (1.47±0.40) times longer than that before drug taking,shorter than 2 times of the recommended normal high value (the normal range of APTT was from 28 s to 45 s in our lab).Conclusions APTT may be taken as the reference index to evaluate the coagulation effect of dabigatran extexilate and drug dosage adjustment.