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AP&T: 直接口服抗凝药和维生素K拮抗剂在导致上消化道出血的危险性中的比较

2021-02-19 MedSci原创 MedSci原创

华法林是国内唯一的维生素K拮抗剂,它几十年以来一直是治疗急性静脉血栓栓塞(包括下肢深静脉血栓和肺栓塞)的标准药物。

      华法林是国内唯一的维生素K拮抗剂,它几十年以来一直是治疗急性静脉血栓栓塞(包括下肢深静脉血栓和肺栓塞)的标准药物。然而,近年来出现的一些新型口服抗凝药(或者叫口服直接抗凝药),其中包括利伐沙班、达比加群、阿哌沙班和艾朵沙班,它们成为过去标准方案的挑战者。为了比较新型药物和华法林的效果和副作用,本项研究对口服抗凝剂治疗导致的上消化道出血(UGIB)的流行病学和结局进行了研究分析。

 

 

       在法国,研究人员进行了一项前瞻性,多中心的研究,纳入了所有连续一年的发生UGIB患者。从队列中筛选出出接受口服抗凝剂治疗的患者作为实验组。主要结局是发生UGIB后6周的死亡率和出血情况,以及需要非内镜治疗的概率。

 

 

       本项研究共纳入2498名患者,有475名(19%)接受口服抗凝剂(DOAC)治疗,多数为维生素K拮抗剂(VKA)(267名患者[56.2%])。除了肾衰竭和肝硬化在VKA组中更为普遍外,各组之间的基线特征相似。73例患者的胃镜检查正常(15.3%);消化性病变是UGIB的主要原因(n = 233,49%)。需要内镜治疗的为128例(26.9%),导致出血消退的比例为74%(n = 95)。6周时的死亡率为12.4%(59例患者),VKA组的死亡率高于DOAC(16.1%VS 7.8%,P <0.01)。通过多变量分析,住院患者中只有Charlson指数≥5和UGIB发生与死亡率独立相关。再出血(56例[11.8%])和需要非内镜治疗的概率(18例[3.8%])与抗凝剂的类型无关。

 

 

      本项研究证实,与VKA相比,DOAC不会改变UGIB的结果。合并症和相关治疗是使UGIB预后恶化的最重要因素。

 

 

原始出处 :

Claire Gouriou. Et al. Outcomes of upper gastrointestinal bleeding are similar between direct oral anticoagulants and vitamin K antagonists. Alimentary Pharmacology & Therapeutics.2021.

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    2021-02-19 jyzxjiangqin

    好文章!

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