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J Thromb Haemost:服用直接口服抗凝药物的脑肿瘤患者颅内出血风险

2018-11-19 xing.T MedSci原创

由此可见,在脑转移或原发性脑肿瘤患者中,相对于LMWH,DOAC与ICH的发生率增加无关。

直接口服抗凝血剂(DOAC)在治疗癌症相关血栓形成方面是有效的,但在某些恶性肿瘤患者中,与低分子量肝素相比,出血风险增加。DOAC是否会增加脑肿瘤患者ICH的发病率尚未确定。近日,血栓和凝血疾病权威杂志Journal of Thrombosis and Haemostasis上发表了一篇研究文章,该研究旨在明确脑肿瘤和静脉血栓栓塞患者与LMWH相比,服用DOAC治疗后ICH的累积发生率。

研究人员进行了一项回顾性比较队列研究。回顾了所有ICH事件患者的影像学图像,主要终点是抗凝治疗开始后12个月ICH的累积发生率。

该研究共评估了172名脑肿瘤患者(42人服用DOAC和131接受LMWH治疗)。在原发性脑肿瘤队列(N=67)中,任何ICH的累积发生率在接受DOAC的患者中为0%,而在接受LMWH治疗的患者中为36.8%(95%CI为22.3-51.3%),其中大ICH发生率为18.2%(95%CI为8.4-31.0)。在脑转移队列(N=105)中,DOAC相对于依诺肝素没有增加任何ICH的风险,其发生率为分别27.8%(95%CI,5.5-56.7%)和52.9%(95%CI为37.4-66.2%)。同样,DOAC未增加脑转移患者大ICH的发生率,累积发生率为11.1%(95%CI为0.5-40.6%)vs. 17.8%(95%CI为10.2-27.2%)。

由此可见,在脑转移或原发性脑肿瘤患者中,相对于LMWH,DOAC与ICH的发生率增加无关。

原始出处:

Brian J. Carney,et al.Intracranial hemorrhage with direct oral anticoagulants in patients with brain tumors. Journal of Thrombosis and Haemostasis.2018. https://onlinelibrary.wiley.com/doi/10.1111/jth.14336

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    2018-11-25 changfy
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    2018-11-19 医者仁心5538

    学习了

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直接口服抗凝药物(NOAC)自上市以来,因其抗凝更高效、不需常规监测INR等优势,受到临床医生的广泛关注。2018年8月,发表在《Journal of the American Heart Association》的一项研究调查了急性缺血性卒中合并非瓣膜性房颤患者中,既往DOAC治疗和脑梗死体积和动脉闭塞部位之间的相关性。

Blood:是否需要监测口服抗凝药的水平?

直接口服抗凝药(DOAC)显著改善了需要抗凝的患者的护理。相比维生素K抗凝剂(VKA)和低分子量肝素(LMWH),DOAC具有相似或更好的效果和安全预后,而且更容易用于门诊患者,现已成为一线用药,适应症包括预防中风、非瓣膜性房颤的系统抗凝和治疗VTE等。DOAC易口服、剂量单一、半衰期短,并且因其治疗窗口广、药物作用少,不需要检测药物水平。但在DOAC使用近十年后,在某些临床情况下是否需要检测DO

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