Stroke:既往卒中或TIA的非瓣膜性房颤患者:3种NOACs vs华法林

2017-08-11 易湛苗 环球医学资讯

2017年8月,发表在《Stroke》的一项研究调查了既往卒中或短暂性脑缺血发作的非瓣膜性房颤患者中,使用非维生素K拮抗剂口服抗凝药(阿哌沙班、达比加群、利伐沙班)vs华法林的疗效

2017年8月,发表在《Stroke》的一项研究调查了既往卒中或短暂性脑缺血发作的非瓣膜性房颤患者中,使用非维生素K拮抗剂口服抗凝药(阿哌沙班、达比加群、利伐沙班)vs华法林的疗效。

背景和目的:对于既往缺血性脑卒中或短暂性脑缺血发作的非瓣膜性房颤患者,比较使用非维生素K拮抗剂口服抗凝药(NOAC)与华法林的真实世界数据有限。

方法:使用2012年1月至2015年6月期间的MarketScan医保数据,研究者确定了新开始使用口服抗凝药的成人,这些成人有2个以上的非瓣膜性房颤诊断代码记录、既往缺血性脑卒中/短暂性脑缺血发作史、在开始使用抗凝药前有≥180天持续医疗和处方报销记录。进行3项分析,比较阿哌沙班vs华法林(n=2514)、达比加群vs华法林(n=1962)和利伐沙班vs华法林(n=5208)的1:1倾向性评分匹配队列。对患者进行随访,直至缺血性脑卒中和颅内出血(ICH)的复合终点出现或大出血、口服抗凝药转换/中断、保险退保或随访结束。所有匹配队列的平均随访期为0.5至0.6年。

结果:使用Cox回归分析,与华法林相比,阿哌沙班和达比加群均不能降低缺血性脑卒中或ICH(风险比[HR],0.70;95%置信区间[CI],0.33~1.48和HR,0.53;95% CI,0.26~1.07)的复合首要终点,也对大出血没有显着影响(HR,0.79;95% CI,0.38~1.64和HR,0.58;95% CI,0.26~1.27)。利伐沙班降低了缺血性脑卒中或ICH的复合终点(HR,0.45;95% CI,0.29~0.72),对大出血没有影响(HR,1.07;95% CI,0.71~1.61)。在3个NOAC分析中, ICH的发生率为0.16~0.61次事件/100患者-年,任何一种NOAC与华法林相比,均无显着性差异。

结论:对于既往卒中/短暂性脑缺血发作史的非瓣膜性房颤患者,这项3种NOACs研究的结果与III期试验和既往卒中/短暂性脑缺血发作亚组分析的结果一致。所有NOACs在缺血性脑卒中、ICH或大出血风险方面不劣于华法林。

原始出处:
Coleman CI, Peacock WF, Bunz TJ, et al.Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation and Previous Stroke or Transient Ischemic Attack.Stroke. 2017 Aug;48(8):2142-2149. doi: 10.1161/STROKEAHA.117.017474. Epub 2017 Jun 27.

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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Aug 13 08:43:48 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279179, encodeId=e3d012e9179c8, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507543, encodeId=8ae1150e5436e, content=<a href='/topic/show?id=528b12904c3' target=_blank style='color:#2F92EE;'>#NOAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12904, encryptionId=528b12904c3, topicName=NOAC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=418f9911898, createdName=30397607, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555858, encodeId=d1a915558584c, content=<a href='/topic/show?id=08611290581' target=_blank style='color:#2F92EE;'>#NOACs#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12905, encryptionId=08611290581, topicName=NOACs)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ae714667420, createdName=一闲, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583520, encodeId=216b1583520c2, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=)]
    2017-12-20 bshuang
  5. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Aug 13 08:43:48 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279179, encodeId=e3d012e9179c8, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507543, encodeId=8ae1150e5436e, content=<a href='/topic/show?id=528b12904c3' target=_blank style='color:#2F92EE;'>#NOAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12904, encryptionId=528b12904c3, topicName=NOAC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=418f9911898, createdName=30397607, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555858, encodeId=d1a915558584c, content=<a href='/topic/show?id=08611290581' target=_blank style='color:#2F92EE;'>#NOACs#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12905, encryptionId=08611290581, topicName=NOACs)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ae714667420, createdName=一闲, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583520, encodeId=216b1583520c2, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=)]
    2017-08-15 明天会更好!

    好好学习,感谢!

    0

  6. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Aug 13 08:43:48 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279179, encodeId=e3d012e9179c8, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507543, encodeId=8ae1150e5436e, content=<a href='/topic/show?id=528b12904c3' target=_blank style='color:#2F92EE;'>#NOAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12904, encryptionId=528b12904c3, topicName=NOAC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=418f9911898, createdName=30397607, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555858, encodeId=d1a915558584c, content=<a href='/topic/show?id=08611290581' target=_blank style='color:#2F92EE;'>#NOACs#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12905, encryptionId=08611290581, topicName=NOACs)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ae714667420, createdName=一闲, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583520, encodeId=216b1583520c2, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=)]
    2017-08-13 ylzr123

    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

  7. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Aug 13 08:43:48 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279179, encodeId=e3d012e9179c8, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507543, encodeId=8ae1150e5436e, content=<a href='/topic/show?id=528b12904c3' target=_blank style='color:#2F92EE;'>#NOAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12904, encryptionId=528b12904c3, topicName=NOAC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=418f9911898, createdName=30397607, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555858, encodeId=d1a915558584c, content=<a href='/topic/show?id=08611290581' target=_blank style='color:#2F92EE;'>#NOACs#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12905, encryptionId=08611290581, topicName=NOACs)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ae714667420, createdName=一闲, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583520, encodeId=216b1583520c2, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=)]
    2017-08-13 yaanren
  8. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Aug 13 08:43:48 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279179, encodeId=e3d012e9179c8, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507543, encodeId=8ae1150e5436e, content=<a href='/topic/show?id=528b12904c3' target=_blank 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    2017-08-13 30397607
  9. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Aug 13 08:43:48 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279179, encodeId=e3d012e9179c8, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507543, encodeId=8ae1150e5436e, content=<a href='/topic/show?id=528b12904c3' target=_blank style='color:#2F92EE;'>#NOAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12904, encryptionId=528b12904c3, topicName=NOAC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=418f9911898, createdName=30397607, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555858, encodeId=d1a915558584c, content=<a href='/topic/show?id=08611290581' target=_blank style='color:#2F92EE;'>#NOACs#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12905, encryptionId=08611290581, topicName=NOACs)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ae714667420, createdName=一闲, createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583520, encodeId=216b1583520c2, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Aug 13 05:32:00 CST 2017, time=2017-08-13, status=1, ipAttribution=)]
    2017-08-13 一闲
  10. 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