摘要
目的 探讨女性易栓症患者口服抗凝治疗期间异常子宫出血(abnormal uterine bleeding,AUB)的发生率及其不良影响。方法 以2013年1月—2023年5月于北京协和医院血液内科出凝血疾病门诊就诊,并接受口服利伐沙班或华法林抗凝治疗的女性易栓症患者为研究对象。回顾性收集抗凝治疗前及治疗后患者的一般临床资料及AUB情况,并根据抗凝治疗药物不同将患者分为利伐沙班治疗组和华法林治疗组。采用广义估计方程分析女性易栓症患者抗凝治疗前后AUB的发生率,探讨不同抗凝治疗药物对AUB发生率的影响。结果 共入选符合纳入与排除标准的女性易栓症患者106例,相较于用药前,AUB的发生率显著增加(56.6%比26.4%,P<0.001),以月经过多(48.1%)和经期延长(21.7%)为主要临床表现。相较于华法林,利伐沙班更易导致AUB(OR=3.3,95%CI:1.5~7.4,P=0.003)。在发生月经过多和经期延长的54例患者中,72.2%(39/54)采取了干预措施,其中经期暂停服用抗凝药是主要干预措施(37.0%),相较于华法林治疗组,利伐沙班治疗组患者更易在经期停药(OR=10.4,95%CI:1.2~87.2,P=0.019)。结论 口服抗凝治疗可显著增加女性易栓症患者AUB的发生风险,且利伐沙班相关AUB的发生风险明显高于华法林。
Objective To investigate the incidence and adverse effects of abnormal uterine bleeding(AUB) during oral anticoagulation therapy in women with thrombophilia.Methods The female patients with thrombophilia who received oral anticoagulation therapy with rivaroxaban or warfarin in the Department of Hematology of Peking Union Medical College Hospital from January 2013 to May 2023 were selected as the study subjects.Their demographic characteristics,disease related data and AUB before and after anticoagulant therapy were retrospectively collected.The patients were divided into rivaroxaban treatment group and warfarin treatment group according to anticoagulant drugs.The generalized estimating equation was used to analyze the difference in the incidence of AUB before and after anticoagulant therapy,and explore the effect of different anticoagulant therapy on AUB.Results A total of 106 female patients with thrombophilia were included,and we found that oral anticoagulation significantly increased the incidence of AUB(56.6% vs.26.4%,P<0.001),predominantly characterized by excessive menstruation(48.1%) and prolonged periods(21.7%).Rivaroxaban was more likely to cause AUB than warfarin(OR=3.3,95% CI:1.5-7.4,P=0.003).Of the patients who experienced excessive menstruation and prolonged periods,72.2%(39/54) required intervention,with suspension of anticoagulants during menstruation as the main intervention(37.0%).The patients taking rivaroxaban were more likely to stop taking them during menstruation compared to those taking warfarin(OR=10.4,95% CI:1.2-87.2,P=0.019).Conclusions Oral anticoagulation therapy significantly increased the incidence of AUB in women with thrombophilia and the risk of AUB associated with rivaroxaban was significantly higher than that with warfarin.
作者
张文静
朱铁楠
李魁星
ZHANG Wenjing;ZHU Tienan;LI Kuixing(Graduate College,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Nursing Department,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Hematology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
出处
《协和医学杂志》
CSCD
北大核心
2024年第1期117-123,共7页
Medical Journal of Peking Union Medical College Hospital
基金
中央高水平医院临床科研专项(2022-PUMCH-B-046)。
关键词
口服抗凝治疗
易栓症
异常子宫出血
oral anticoagulation therapy
thrombophilia
abnormal uterine bleeding
