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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.
Résumé
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.
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Objective To investigate the effects and mechanisms of up-regulation of heme oxygenase-1(HO-1)on uric acid-induced adipocyte dysfunction. Methods Human bone marrow-derived mesenchymal stem cells(MSCs)were cultured in vitro and second or third generation MSCs were selected and recultured in an adipogenic induction medium,with the addition of various amounts of fructose and uric acid to find the optimal concentrations.Then,the HO-1 inducer cobalt protoporphyrin (CoPP)and the HO-1 inhibitor tin porphyrin(SnMP)were added successively.There were five independent samples in each group.Adipogenesis in MSC-derived adipocytes and droplets were measured by spectrophotometry,expression levels of xanthine oxidase(XO)and NADPH were measured by Western blott,superoxide levels were measured by Luminous spectrometer,and levels of adipogenic markers and HO-1 were measured by reverse transcription-polymerase chain reaction(RT-PCR). Results Fructose at 500 μmol/L and uric acid at 50 mg/L were the optimal concentrations for stimulating adipogenesis in MSC-derived adipocytes(P< 0.05).Compared with the controls,fructose significantly increased the levels of XO expression and uric acid(P< 0.05),and concurrent treatment with fructose and CoPP effectively reversed both XO and uric acid levels to those of the controls(all P<0.05).However,SnMP negated the beneficial effects of CoPP(P< 0.05).Additionally,uric acid decreased the number of small droplets and increased expression levels of adipogenic markers and NADPH(all P<0.05),but proadipogenic mediator levels were reduced with the addition of CoPP(all P<0.05).Furthermore,uric acid reduced expression levels of Wnt 10b,but had no significant effect on HO-1 expression,andthese effects were reversed upon the addition of CoPP(all P<0.05). Conclusions Upregulation of HO-1 can reduce the levels of XO and uric acid,adipogenesis in MSC-derived adipocytes,and also the expression of adipogenic markers and NADPH.Therefore,it plays a role in antioxidant stress.HO-1 agonists may be targets for treating organ damage and controlling weight in elderly obese patients with metabolic syndrome.
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Objective To study the association between serum TB level and target organ damage in elderly metabolic syndrome (MS) patients.Methods Two hundred and forty-five elderly MS patients admitted to our hospital were included in this study.Their general condition was recorded,their serum TB,blood glucose,blood lipids,blood urea nitrogen and creatinine (Cr) levels were measured,and their left ventricular mass (LVM) and left ventricular mass index (LVMI) were detected by parallel echocardiography.Results Correlation analysis showed that the serum TB level was positively related with that of Cr (r=0.168,P=0.009) but not related with LVM,LVMI,serum blood urea nitrogen level,prevalence of chronic renal insufficiency and chronic kidney disease (P＞0.05).Regression analysis showed that serum TB level was an independent risk factor for urea in MS patients (OR=-0.27,95％CI:-0.48-0.06,P=0.01;OR=1.27,95％CI:0.33-2.22,P=0.01).Quantile analysis of serum TB level showed that the serum Cr level was significantly higher in Q76-100 group,Q51-75 group and Q26-50 group than in Q1-25 group (P=0.031).Conclusion Serum TB level is positively related with endogenous Cr clearance in elderly MS patients,suggesting that mildly elevated serum TB level may be a protective factor for impaired renal function in elderly MS patients.