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引用次数: 0
摘要
背景：由于与年龄相关的血栓栓塞和出血风险，80岁老人的最佳抗凝策略仍然存在争议。本研究评估了减少剂量的依多沙班（每天15-30毫克）在老年人群中的实际效果。方法：对2022-2023年北京大学第一医院接受依多沙班治疗的217例患者（年龄≥80岁）进行回顾性队列研究。按剂量对患者进行分层（30 mg每日一次[QD] [n = 95] vs 15 mg每日一次[n = 122]）。结果包括药效学（抗xa水平）、临床终点（出血、血栓形成和死亡率）和生存分析。结果：15 mg- qd组年龄较大（90.0岁vs 85.8岁，P = 0.001），日常生活活动（ADL）评分降低（65.5% vs 82.6, P = 0.003），肾小球滤过率（eGFR）估计降低（58.6 vs 62.6 mL/min/1.73 m2, P = 0.005）。Anti-Xa峰值水平分别为0.56±0.25 IU/mL （30 mg）和0.35±0.15 IU/mL （15 mg）。在15.8±9.8个月的随访中，30mg组死亡率降低（0.7% vs 3.5%, P = 0.044），出血（3.5%）和血栓形成（0.7%）发生率相当。结论：小剂量依多沙班在高龄患者中表现出良好的安全性和有效性，有必要进行全面的缺血性出血风险评估，以优化个体化抗凝方案。
Reduced-Dose Edoxaban in Patients Aged ≥ 80 Years: A Single-Center Real-World Analysis.
Background: Optimal anticoagulation strategies in octogenarians remain controversial owing to age-related risks of thromboembolism and bleeding. This study evaluates real-world outcomes of reduced-dose edoxaban (15-30 mg daily) in very old populations.
Methods: We conducted a retrospective cohort study of 217 patients (aged ≥ 80 years) receiving edoxaban at Peking University First Hospital (2022-2023). Patients were stratified by dosage (30 mg once daily [QD] [n = 95] versus 15 mg QD [n = 122]). Outcomes included pharmacodynamics (anti-Xa levels), clinical endpoints (bleeding, thrombosis, and mortality), and survival analysis.
Results: The 15-mg-QD group was older (90.0 versus 85.8 years, P = 0.001) and had reduced activities of daily living (ADL) scores (65.5% versus 82.6, P = 0.003) and reduced estimated glomerular filtration rate (eGFR) (58.6 versus 62.6 mL/min/1.73 m2, P = 0.005). Anti-Xa peak levels were 0.56 ± 0.25 IU/mL (30 mg) versus 0.35 ± 0.15 IU/mL (15 mg). Over 15.8 ± 9.8 months follow-up, mortality was reduced in the 30-mg group (0.7% versus 3.5%, P = 0.044), with comparable bleeding (3.5% overall) and thrombosis (0.7%) rates.
Conclusions: Reduced-dose edoxaban demonstrates a favorable safety-efficacy profile in advanced-age patients, necessitating comprehensive bleeding-ischemic risk assessment to optimize individualized anticoagulation regimens.
期刊介绍：
Drugs & Aging delivers essential information on the most important aspects of drug therapy to professionals involved in the care of the elderly.
The journal addresses in a timely way the major issues relating to drug therapy in older adults including: the management of specific diseases, particularly those associated with aging, age-related physiological changes impacting drug therapy, drug utilization and prescribing in the elderly, polypharmacy and drug interactions.
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