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Stroke:DVT/PE:DOACs的优越性再添一项 ICH显著降低

2018-08-08 王淳 环球医学

静脉血栓栓塞症(VTE),包括深静脉血栓形成(DVT)、肺栓塞(PE)等,严重影响患者生存率。抗凝药是重要的治疗选择。长期以来,华法林一直是标准的抗凝治疗药物。

静脉血栓栓塞症(VTE),包括深静脉血栓形成(DVT)、肺栓塞(PE)等,严重影响患者生存率。抗凝药是重要的治疗选择。长期以来,华法林一直是标准的抗凝治疗药物。

近年来,基于血栓栓塞性疾病所造成的巨大社会经济负担,以及现有口服抗凝药固有的缺陷,一些直接口服抗凝药(DOACs)被开发并上市,作为华法林的替代选择。DOACs的早期经验证实,其可能为DVT/PE更加安全、同样有效的选择。

非创伤性颅内出血(ICH)是抗凝治疗最具毁灭性的潜在并发症之一。2018年7月,发表在《Stroke》的一项研究,调查了DOACs vs华法林治疗DVT/PE患者的ICH发生率。

在该项研究中,研究人员采用MarketScan商业保险和Medicare补充数据库,在无房颤且处方DOAC或华法林的成年DVT/PE患者中,对其ICH住院事件进行随访。研究人员采用粗化精确匹配以平衡治疗队列,采用Cox比例风险回归和Kaplan-Meier生存曲线估算DOACs同华法林相比与ICH风险之间的相关性。

联合队列218620名患者的中位随访期是3.0个月,平均年龄55.4岁,52.1%为女性。

结果显示,DOAC队列有26980名患者,发生8例ICH事件(每1000人-年中1.0例);华法林队列有191640名患者,发生324例ICH事件(每1000人-年中3.3例;P<0.0001)。

在未匹配(风险比=0.26;P=0.0002)和匹配的(风险比=0.20;P=0.0001)Cox比例风险回归中,同华法林相比,DOAC队列ICH风险比较低。

该研究表明,在VTE患者人群中,与华法林相比,DOACs能降低非创伤性ICH的发生率。作者认为,在DVT/PE患者的ICH风险方面,DOACs的安全性优于华法林。

当前,DOACs治疗血栓栓塞性疾病的多个临床适应证已获得批准。DOACs因其出血风险小、无需常规检测INR、抗凝效果显着等优点,越来越受到医生和患者的认可。该项研究证实,其安全性也优于传统的华法林。无疑,DOACs为VTE患者更佳的选择。当然,患者如何选择药物,还应考虑费用等问题。

原始出处:

Lamsam L, et al. Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation: Direct Oral Anticoagulants Versus Warfarin. Stroke. 2018 Jul 10. pii: STROKEAHA.118.022156. doi: 10.1161/STROKEAHA.118.022156.

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    2019-05-02 膀胱癌
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    2018-10-29 feather89
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    2018-11-21 amy0558
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    2018-08-22 zwjnj2

    好好学习天天向上

    0

  5. 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    2018-08-10 yaanren
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    2018-08-10 diushouji
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  8. 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    2018-08-08 哈哈869

    作者从极其专业的角度论述了大结节角的测量方法,使我们对影像学的专业诊断知识有了进一步的了解,多谢分享!

    0

  9. 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    2018-08-08 lietome2

    好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。

    0

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