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JACC:TAVR过程中,比伐卢定并不优于肝素的效果

2015-12-22 MedSci MedSci原创

抗凝治疗是经导管主动脉瓣置换术(TAVR)的必需程序。虽然一个最佳方案尚未确定,但主要用肝素。直接凝血酶抑制比伐卢定可能是在此过程中用于抗血凝剂一种有效的替代肝素药物。 本研究的目的是确定是否比伐卢定可以替代肝素作为接受TAVR的患者的抗凝血剂。共有802例主动脉瓣狭窄患者被随机分配接受经股TAVR比伐卢定 vs 肝素。2个主要终点是48小时内或出院前严重出血事件(以先发生为准)和30天

抗凝治疗是经导管主动脉瓣置换术(TAVR)的必需程序。虽然一个最佳方案尚未确定,但主要用肝素。直接凝血酶抑制比伐卢定可能是在此过程中用于抗血凝剂一种有效的替代肝素药物。 

本研究的目的是确定是否比伐卢定可以替代肝素作为接受TAVR的患者的抗凝血剂。

共有802例主动脉瓣狭窄患者被随机分配接受经股TAVR比伐卢定 vs 肝素。2个主要终点是48小时内或出院前严重出血事件(以先发生为准)和30天的不良临床事件,定义为主要心血管不良事件(全因死亡,心肌梗死卒中)以及大出血。

用比伐卢定 vs 肝素抗凝都没有达到优势,因为它降低48小时大出血概率(6.9% vs 9.0%;相对风险:0.77;95%可信区间(Cl):0.48至1.23,P=0.27)或30天不良心血管事件(14.4% vs 16.1%;相对风险:0.89;95%Cl:0.64至1.24;风险差异:-1.72;95%Cl:-6.70至3.25;P =0.50);关于后者,预先设定的非劣性假设已经达到了(pnoninferiority<0.01)。在48小时的主要心血管不良事件的发生率并没有显著差异(3.5% vs 4.8%;相对风险:0.73;95%Cl:0.37至1.43;P=0.35)。在48小时,比伐卢定组心肌梗死事件显著减少,但较肝素组发生更多的急性肾损伤的事件;30天时,这些差异不再显著。

在这项随机的TAVR程序药物试验中,与肝素相比,比伐卢定没有降低在48小时的大出血概率或30天之内不良心血管事件。虽然优越性未示出,但非劣性假设对于后者的因素是吻合的。鉴于成本较低,肝素仍然是护理的标准,比伐卢定可以作为患者进行TAVR时不能接收肝素的抗凝剂选择。

原始出处:

George D. Dangas,Thierry Lefèvre,Christian Kupatt,et al.Bivalirudin Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement,JACC,2915.12.22

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    2016-03-11 hbwxf
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    2016-01-09 medsic

    好文章!

    0

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    2016-01-09 medsic

    嗯,

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1667769, encodeId=fdce166e7693d, content=<a href='/topic/show?id=676c636260c' target=_blank style='color:#2F92EE;'>#比伐卢定#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63626, encryptionId=676c636260c, topicName=比伐卢定)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a96426178489, createdName=Luyuxie_18, createdTime=Tue Apr 05 23:06:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853456, encodeId=529c1853456ef, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Fri Mar 11 03:06:00 CST 2016, time=2016-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086296, encodeId=5de020862960c, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Fri Mar 18 12:06:00 CST 2016, time=2016-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55122, encodeId=160a551226d, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 22:08:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55123, encodeId=a27a551230b, content=嗯,, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 22:08:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325152, encodeId=8a2213251527b, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Thu Dec 24 13:06:00 CST 2015, time=2015-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=47371, encodeId=a5e94e371e2, content=收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ded71629504, createdName=nizongzan, createdTime=Thu Dec 24 06:59:00 CST 2015, time=2015-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=47372, encodeId=f2064e37294, content=不错的东东, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ded71629504, createdName=nizongzan, createdTime=Thu Dec 24 06:59:00 CST 2015, time=2015-12-24, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1667769, encodeId=fdce166e7693d, content=<a href='/topic/show?id=676c636260c' target=_blank style='color:#2F92EE;'>#比伐卢定#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63626, encryptionId=676c636260c, topicName=比伐卢定)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a96426178489, createdName=Luyuxie_18, createdTime=Tue Apr 05 23:06:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853456, encodeId=529c1853456ef, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Fri Mar 11 03:06:00 CST 2016, time=2016-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086296, encodeId=5de020862960c, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Fri Mar 18 12:06:00 CST 2016, time=2016-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55122, encodeId=160a551226d, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 22:08:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55123, encodeId=a27a551230b, content=嗯,, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 22:08:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325152, encodeId=8a2213251527b, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Thu Dec 24 13:06:00 CST 2015, time=2015-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=47371, encodeId=a5e94e371e2, content=收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ded71629504, createdName=nizongzan, createdTime=Thu Dec 24 06:59:00 CST 2015, time=2015-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=47372, encodeId=f2064e37294, content=不错的东东, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ded71629504, createdName=nizongzan, createdTime=Thu Dec 24 06:59:00 CST 2015, time=2015-12-24, status=1, ipAttribution=)]
    2015-12-24 nizongzan

    收藏

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1667769, encodeId=fdce166e7693d, content=<a href='/topic/show?id=676c636260c' target=_blank style='color:#2F92EE;'>#比伐卢定#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63626, encryptionId=676c636260c, topicName=比伐卢定)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a96426178489, createdName=Luyuxie_18, createdTime=Tue Apr 05 23:06:00 CST 2016, time=2016-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853456, encodeId=529c1853456ef, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Fri Mar 11 03:06:00 CST 2016, time=2016-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086296, encodeId=5de020862960c, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Fri Mar 18 12:06:00 CST 2016, time=2016-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55122, encodeId=160a551226d, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 22:08:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55123, encodeId=a27a551230b, content=嗯,, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 22:08:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325152, encodeId=8a2213251527b, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Thu Dec 24 13:06:00 CST 2015, time=2015-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=47371, encodeId=a5e94e371e2, content=收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ded71629504, createdName=nizongzan, createdTime=Thu Dec 24 06:59:00 CST 2015, time=2015-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=47372, encodeId=f2064e37294, content=不错的东东, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ded71629504, createdName=nizongzan, createdTime=Thu Dec 24 06:59:00 CST 2015, time=2015-12-24, status=1, ipAttribution=)]
    2015-12-24 nizongzan

    不错的东东

    0

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