The Efficacy And Safety Of Low-dose Rivaroxaban In Elderly Patients With Non-valvular Atrial Fibrillation

Objective:To compare the efficacy and safety of low-dose rivaroxaban(10mg·d^-1),15mg·d^-1rivaroxaban and warfarin in elderly patients with non-valvular atrial fibrillation,and to further explore the effect of frailty on anticoagulation therapy,in order to provide clinicians with reference for anticoagulation therapy in elderly patients with non-valvular atrial fibrillation.Methods:A total of 102 elderly patients with non-valvular atrial fibrillation who were hospitalized and treated in the First Affiliated Hospital of University of Science and Technology of China（Anhui Provincial Hospital）from January 2020 to January 2022were selected.According to the different prescription of anticoagulant drugs,they were divided into rivaroxaban 10mg·d^-1group,rivaroxaban 15mg·d^-1group and warfarin group.The clinical data of age,gender,height,weight,body mass index（BMI）,blood routine,liver and kidney function,coagulation function,and other combined diseases of the patients were collected.Then the patients in the three groups were divided into frail group and non-frail group by Frail scale.The Frail scale score of non-frail group was less than 3.During a mean follow-up of 12 months,thromboembolism,bleeding and death events were recorded in the three groups.The changes of platelet,liver and kidney function,coagulation function and other indicators before and after treatment were compared.The thromboembolic events,bleeding events and death events were compared between the frail and non-frail patients in the three groups.Result:There were no statistically significant differences in platelet count,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,creatinine（Cr）and blood urea nitrogen（BUN）among the three groups after treatment and before treatment（P>0.05）.There were no statistically significant differences in coagulation indexes between before and after treatment in rivaroxaban 10mg·d^-1group and rivaroxaban15mg·d^-1group（P>0.05）.The prothrombin time（PT）and activated partial thromboplastin time（APTT）of patients in warfarin group after treatment were longer than those before treatment,and the differences were statistically significant（P<0.05）.There were no statistically significant differences in the total incidence of thrombotic events,bleeding events and mortality among the three groups（P>0.05）.The risk of gastrointestinal bleeding in rivaroxaban 15mg·d^-1group was higher than that in rivaroxaban 10mg·d^-1group,the odds ratio（OR）was 11.82,95%confidence interval（CI）was 1.28-109.3,the difference was statistically significant.There was no significant difference in the incidence of thromboembolic events,all-cause death,mild to moderate and severe bleeding and total bleeding between frail and non-frail patients in the 10mg·d^-1group（P>0.05）.In the rivaroxaban 15mg·d^-1group,there were no significant differences in thromboembolic events,mild to moderate bleeding and severe bleeding between frail and non-frail patients（P>0.05）,but there were significant differences in all-cause death and total bleeding incidence（P<0.05）.In the warfarin group,there were no significant differences in thromboembolic events and mild to moderate bleeding between frail and non-frail patients（P>0.05）,but there were significant differences in all-cause death,severe bleeding and total bleeding rates（P<0.05）.Conclusion:1.The efficacy of low dose(10mg·d^-1)rivaroxaban was similar to that of 15mg·d^-1rivaroxaban and warfarin in the anticoagulant therapy of elderly patients with non-valvular atrial fibrillation,but 10mg·d^-1rivaroxaban had a lower risk of gastrointestinal bleeding than 15mg·d^-1rivaroxaban.2.Frailty should be assessed during anticoagulant therapy in elderly patients with non-valvular atrial fibrillation.10mg·d^-1rivaroxaban may be safer for elderly patients with non-valvular atrial fibrillation complicated with frailty.