摘要目的:观察老年患者服用达比加群酯抗凝治疗的疗效并分析影响因素。方法:收集北京大学第一医院老年内科因预防或治疗血栓使用达比加群酯的老年患者临床资料，分析服用达比加群不同剂量时凝血指标变化并探讨其影响因素。结果:入选服用达比加群酯的患者142例，年龄(79.0±7.5)岁。其中，心房颤动(房颤)128例，深静脉血栓及肺栓塞14例。服用达比加群酯后，所有患者活化部分凝血活酶时间(APTT)、凝血酶时间(TT)谷值均较用药前增加( P<0.001)。服用110 mg，1次/d的患者，用药前APTT(32.4±3.0)s，用药后谷值(41.4±5.4)s，峰值(53.9±9.8)s；服用110 mg，2次/d者，用药前APTT(31.0±3.1)s，用药后谷值(42.4±5.5)s，峰值(48.7±7.3)s。服用达比加群酯110 mg/d的患者年龄更大( P<0.001)，女性比例更高( P<0.001)、体重( P＝0.001)及体质指数(BMI)更低( P＝0.018)、肌酐清除率更低( P<0.001)，APTT基础值( P＝0.008)及峰值( P＝0.002)更高，APTT谷值与220 mg/d比较差异无统计学意义( P>0.05)。多因素分析表明，用药前APTT( β＝0.885， P<0.001)、肌酐清除率( β＝－0.121， P<0.001)、达比加群酯剂量( β＝0.037， P<0.001)、合用胺碘酮( β＝3.784， P＝0.022)均与APTT谷值相关。 结论:达比加群酯抗凝疗效存在个体差异，用药前APTT高、达比加群酯剂量大、肌酐清除率低以及合用胺碘酮均使APTT谷值更高。部分女性、高龄、低体重及肾功能下降的患者使用达比加群酯110 mg/d，APTT谷值与220 mg/d相似，而峰值更高。

abstractsObjective:To observe the efficacy of Dabigatran etexilate anticoagulation therapy and analyze its influencing factors in elderly patients.Methods:The clinical data of the elderly patients using Dabigatran etexilate anticoagulation for prevention or treatment of thrombosis in the Department of Geriatrics, Peking University First Hospital were collected.Changes of coagulation indexes and its influencing factors were analyzed when taking Dabigatran in different doses.Results:A total of 142 patients receiving Dabigatran therapy were collected, with an average age of(79.0±7.5)years.Among them, 128 patients had atrial fibrillation and 14 had deep venous thrombosis and/or pulmonary embolism.After taking Dabigatran, the trough values of activated partial thromboplastin time(APTT)and thrombin time(TT)were increased significantly in all patients compared with that before administration( P<0.001). In patients taking Dabigatran 110 mg once a day, APTT was(32.4±3.0)s before administration, with a trough value of(41.4±5.4)s and a peak value of(53.9±9.8)s.In patients taking Dabigatran 110 mg twice a day, APTT was(31.0±3.1)s before administration, with a trough value of(42.4±5.5)s and a peak value of(48.7±7.3)s.Compared with patients taking Dabigatran 220 mg/d, those who took Dabigatran 110 mg/d were older( P<0.0001), often women( P<0.0001), had lower body weight( P=0.001), body mass index( P=0.018)and creatinine clearance rate( P<0.001), and higher basal( P=0.008)and peak values( P=0.002)of APTT, but with similar trough values.Multivariate analysis showed that the APTT trough values were significantly related with APTT basal value( β=0.885, P<0.001), creatinine clearance rate( β=-0.121, P<0.001), dosage of Dabigatran( β=0.037, P<0.001)and combined amiodarone( β=3.784, P=0.022). Conclusions:There are individual differences in the anticoagulant effect of Dabigatran etexilate.The APTT trough value is higher in patients with high APTT basal value, high Dabigatran dose, low creatinine clearance rate and combined use of amiodarone.Dabigatran 110 mg/d was often used in women, elderly patients, and those with low body weight, and decreased renal function, and with a similar trough value and a high peak value of APTT compared with patients on Dabigatran 220 mg/d.