The efficacy and safety of Rivaroxaban for elderly patients with thrombotic diseases / 中华老年医学杂志

Objective@#To investigate the efficacy and safety of Rivaroxaban for elderly patients with thrombotic diseases.@*Methods@#This was a retrospective study.A total of 301 elderly patients taking Rivaroxaban from October 2012 to November 2017 at the Second Medical Center of the Chinese PLA General Hospital were consecutively selected.The ages ranged from 60 to 102 years, with an average age of(86.5±8.4)years.Anticoagulation regimens were developed based on comprehensive evaluation of indications, creatinine clearance, ischemia and bleeding risk.Patients were divided into a Rivaroxaban 2.5-5.0 mg/d group(n=72), a 10.0 mg/d group(n=205), and a 15.0-20.0 mg/d group(n=24). Hepatic function, renal function, and coagulation indexes were measured before and after the administration of Rivaroxaban.Fatal bleeding, cardiovascular deaths, all-cause deaths, non-fatal bleeding and thromboembolic events were recorded during the follow-up period.@*Results@#The average dose of Rivaroxaban was(9.3±3.0)mg/d, and the minimum dose was 2.5 mg/d.The average follow-up time was(14.9± 13.9)months and the longest follow-up time was 48 months.One patient had intracranial bleeding.Twenty patients(6.6%)died with a cumulative incidence of 25.2%, three(1.0%)died of cardiac events, and 55.0% died of pneumonia and multiple organ failure.Forty patients(13.3%)had non-fatal hemorrhagic events with a cumulative incidence of 42.4%.Seven patients(2.3%)had thromboembolic events with a cumulative incidence of 16.0%, including 2 cases of non-fatal myocardial infarction, 3 cases of cerebral infarction and 2 cases of deep vein thrombosis.After treatment, levels of prothrombin time and fibrinogen significantly increased while levels of D-dimer significantly deceased(P<0.05).@*Conclusions@#Compared with previous reports, low-dose Rivaroxaban is safe and effective for elderly patients with thrombotic diseases.However, the risk of bleeding and ischemia should be comprehensively evaluated, and appropriate doses of Rivaroxaban should be selected individually.

The efficacy and safety of Rivaroxaban for elderly patients with thrombotic diseases / 中华老年医学杂志

Objective To investigate the efficacy and safety of Rivaroxaban for elderly patients with thrombotic diseases.Methods This was a retrospective study.A total of 301 elderly patients taking Rivaroxaban from October 2012 to November 2017 at the Second Medical Center of the Chinese PLA General Hospital were consecutively selected.The ages ranged from 60 to 102 years,with an average age of(86.5 ± 8.4) years.Anticoagulation regimens were developed based on comprehensive evaluation of indications,creatinine clearance,ischemia and bleeding risk.Patients were divided into a Rivaroxaban 2.5-5.0 mg/d group(n=72),a 10.0 mg/d group(n=205),and a 15.0-20.0 mg/d group (n=24).Hepatic function,renal function,and coagulation indexes were measured before and after the administration of Rivaroxaban.Fatal bleeding,cardiovascular deaths,all-cause deaths,non-fatal bleeding and thromboembolic events were recorded during the follow-up period.Results The average dose of Rivaroxaban was(9.3±3.0)mg/d,and the minimum dose was 2.5 mg/d.The average follow-up time was(14.9± 13.9)months and the longest follow-up time was 48 months.One patient had intracranial bleeding.Twenty patients (6.6％)died with a cumulative incidence of 25.2％,three (1.0％)died of cardiac events,and 55.0％ died of pneumonia and multiple organ failure.Forty patients (13.3％)had non-fatal hemorrhagic events with a cumulative incidence of 42.4％.Seven patients (2.3％)had thromboembolic events with a cumulative incidence of 16.0％,including 2 cases of nonfatal myocardial infarction,3 cases of cerebral infarction and 2 cases of deep vein thrombosis.After treatment,levels of prothrombin time and fibrinogen significantly increased while levels of D-dimer significantly deceased (P ＜ 0.05).Conclusions Compared with previous reports,low-dose Rivaroxaban is safe and effective for elderly patients with thrombotic diseases.However,the risk of bleeding and ischemia should be comprehensively evaluated,and appropriate doses of Rivaroxaban should be selected individually.

Cardiac functional alterations and its risk factors in elderly patients with obstructive sleep apnea syndrome free of cardiovascular disease / 南方医科大学学报

OBJECTIVE@#To evaluate the changes of cardiac structure and function and their risk factors in elderly patients with obstructive sleep apnea syndrome (OSA) without cardiovascular complications.@*METHODS@#Eighty-two elderly OSA patients without cardiovascular disease admitted between January, 2015 and October, 2016 were enrolled in this study. According to their apnea-hypopnea index (AHI, calculated as the average number of episodes of apnoea and hypopnoea per hour of sleep), the patients were divided into mild OSA group (AHI < 15) and moderate to severe OSA group (AHI ≥ 15). The demographic data and the general clinical data were recorded and fasting blood samples were collected from the patients on the next morning following polysomnographic monitoring for blood cell analysis and biochemical examination. Echocardiography was performed within one week after overnight polysomnography, and the cardiac structure, cardiac function and biochemical indexes were compared between the two groups.@*RESULTS@#Compared with those with mild OSA group, the patients with moderate to severe OSA had significantly higher hematocrit (0.22±0.08 @*CONCLUSIONS@#Cardiac diastolic function impairment may occur in elderly patients with moderate or severe OSA who do not have hypertension or other cardiovascular diseases, and the severity of the impairment is positively correlated with AHI.

Correlation between severity of obstructive sleep apnea syndrome and red cell distribution width in elderly patients / 南方医科大学学报

OBJECTIVE@#To investigate the correlation between the severity of obstructive sleep apnea syndrome (OSAS) and red cell distribution width (RDW) in elderly patients.@*METHODS@#A cross-sectional study was conducted among 311 elderly patients diagnosed with OSAS in the snoring clinic between January, 2015 and October, 2016 and 120 healthy controls without OSAS from physical examination populations in the General Hospital of PLA. The subjects were divided into control group with apnea-hypopnea index (AHI) <5 (=120), mild OSAS group (AHI of 5.0-14.9; =90), moderate OSAS group (AHI of 15.0-29.9; =113) and severe OSAS group (AHI ≥ 30; =108). The clinical characteristics and the results of polysomnography, routine blood tests and biochemical tests of the subjects were collected. Multiple linear regression analysis was used to examine the correlation between OSAS severity and RDW.@*RESULTS@#The levels of RDW and triglyceride were significantly higher in severe OSAS group than in the other groups ( < 0.01). The levels of fasting blood glucose and body mass index were significantly higher in severe and moderate OSAS groups than in mild OSAS group and control group ( < 0.05 or < 0.01). Multiple linear regression analysis showed that AHI was positively correlated with body mass index (β=0.111, =0.032) and RDW (β=0.106, =0.029). The area under ROC curve of RDW for predicting the severity of OSAS was 0.687 (=0.0001).@*CONCLUSIONS@#The RDW increases as OSAS worsens and may serve as a potential marker for evaluating the severity of OSAS.

Relationship between sleep duration and the risk of stroke in Asian populations:A meta-analysis / 中华老年医学杂志

Objective To investigate the relationship between sleep duration and the risk of stroke in Asian populations.Methods Using duration of sleep,stroke and cerebrovascular event as search terms,we searched the China National Knowledge Internet (CNKI),Wanfang,Chinese BioMedical Literature(CBM),Vip Citation Databases(VIP),PubMed,EMBASE and Science Citation Index databases from the time of database construction to April 1,2018.Observational studies including cross-sectional studies,case-control studies and cohort studies that aimed to investigate the relationship between sleep duration and the risk of stroke in Asian populations were collected.Two investigators independently screened the literature,extracted data and assessed the quality of included studies.All analyses were performed by using the Stata 12.0 software.Results A total of 18 studies,including 658 778 participants,were included in this meta-analysis.Pooled results showed that short sleep duration was not associated with increased risk of stroke(OR =1.08,95 ％CI:0.96-1.22,Z =1.27,P =0.205),but long sleep duration was associated with increased risk of stroke(OR =1.61,95 ％CI:1.42-1.83,Z =7.49,P ＜ 0.001).Subgroup analysis showed that short sleep duration was correlated with a high risk of stroke only in the Singaporean population while it was not the case in other Asian populations,and long sleep duration was correlated with a high risk of stroke in many studies except in pooled results of case-control studies and pooled research results concerning the Korean population.Conclusions Long but not short sleep duration is a risk factor for the incidence of stoke in Asian populations.