| ObjectiveTo detect the anti-thromboembolic efficacy and safety of different schemes of rivaroxaban by case analysis and survival analysis of thromboembolic and hemorrhagic events in the elderly patients with thromboembolism,also to find reasonable and optimal evidence-based prophylactic and therapeutic schemes of rivaroxaban for elderly patients with thromboembolism.Methods263 elderly patients with high risk or established thromboembolism were enrolled in this retrospective study,all patients were administered with oral rivaroxaban of different dosages.Patients were all admitted in the geriatric cardiology departments of Chinese PLA General Hospital from January 2012 to October 2017.According to different anticoagulant strategies,patients were divided into 3 groups:small dosage group(38 cases),with rivaroxaban of application dose 2.5-7.5mg;the routine dosage of rivaroxaban group(194 cases),rivaroxaban 10-20mg was given;rivaroxaban combination group(31 cases),with rivaroxaban 2.5-1 0mg combine with clopidogrel hydrogen sulphate 75mg.Medical records of all patients were collected and analyzed by consulting medical records,telephone follow-up and so on.The main adverse cardiovascular and cerebrovascular events were recorded in hospital and one year after discharged.Kaplan-Meiers survival analysis was used to compare the incidence of thromboembolism and hemorrhage among three groups.ResultsAmong 263 cases,244 cases were male and 19 cases were female,with an average age of(87.53 ±5.09)years old.There was no significant difference in the results of blood routine,liver and renal function among three groups before and after treatment.There was no significant difference in sex,risk factors,past history,accompanying treatment and laboratory examinations among the three groups(P>0.05).The age of the low dose group was significantly higher than that of the routine group(90.26 ±4.99 vs 86.68±4.96,p=0.000).The age of the combined treatment group was significantly higher than that of the routine group(89.52 ± 4.33 vs 86.68 ± 4.96,p=0.006).Kaplan-Meiers survival analysis showed that there was no significant difference in the incidences of thromboembolism and hemorrhage among the three groups(P>0.05).Conclusions1.The clinical prevention and treatment of thromboembolic diseases in the elderly should be based on the comprehensive evaluations and the schemes should be given individually.2.The comprehensive evaluation of clinical prevention and treatment of thromboembolic diseases in elderly patients should focus on the factors such as the past histories of thromboembolism and hemorrhage,the risks of new thromboembolism and hemorrhage,liver and kidney function,the coexistence of diseases and combined use of drugs.3.According to the comprehensive evaluation,treated with low dose rivaroxaban,conventional dose rivaroxaban and clopidogrel combined with rivaroxaban,respectively,were all the reasonable choice for prevention and treatment of thromboembolism in the elderly patients.4.For those elderly patients with high risk of bleeding tendency and renal dysfunction,the dosage of rivaroxaban should be reduced to less than 10 mg.However,the effect of small dose of rivaroxaban on prevention and treatment of thromboembolic diseases were confirmed.5.In the elderly patients with high risk thromboembolism and relatively profound liver and kidney functions,it is not only effective but also relatively safety to use conventional dosages of rivaroxaban and rivaroxaban combined with clopidogrel to prevent and treat the elderly patients with high risk thromboembolism.6.The elderly patients treated with different schemes of rivaroxaban were feasible with high compliance.7.During the whole period of treatment in elderly patients with different rivaroxaban schemes,signs of bleeding,coagulation index,liver and kidney functions should be followed up dynamically so that comprehensive evaluation be made timely,and the treatment plan be adjusted accordingly. |
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