Ann Intern Med:临床实践中达比加群和华法林治疗房颤结局如何?

2018-02-05 门鹏、吴星 环球医学

2017年12月,发表在《Ann Intern Med》的一项由美国科学家进行的回顾性队列研究,考察了临床实践中达比加群和华法林治疗房颤的结局。

2017年12月,发表在《Ann Intern Med》的一项由美国科学家进行的回顾性队列研究,考察了临床实践中达比加群和华法林治疗房颤的结局。

背景:房颤试验中,与华法林相比,达比加群(150 mg每日2次)与更低的卒中发生率相关,但缺乏大型的临床实践评价。

目的:比较实践中使用达比加群与华法林的患者的卒中、出血和房颤发生率。

设计:回顾性队列。

地点:美国国家食品和药物管理局(FDA)哨兵网络。

患者:2010年11月~2014年5月,初始使用达比加群或华法林疗法的成人房颤患者。

测量指标:开始使用达比加群或华法林的倾向评分匹配患者医院赔付中的缺血性卒中、颅内出血、颅外出血和心梗。

结果:开始使用达比加群疗法的25289例患者和开始使用华法林的25289例倾向匹配患者中,使用达比加群的患者,缺血性卒中(0.80 vs 0.94次事件每100人-年;风险比[HR],0.92 [95% CI,0.65~1.28])或颅外出血(2.12 vs 2.63次事件每100人-年;HR,0.89 [CI,0.72~1.09])率没有显着差异,但不太可能发生颅内出血(0.39 vs 0.77次事件每100人-年;HR,0.51 [CI,0.33~0.79]),且更可能发生心梗(0.77 vs 0.43次事件每100人-年;HR,1.88 [CI,1.22~2.90])。然而,在敏感性分析和暴露定义中,达比加群的使用与心梗之间的相关性强度和显着性具有差异(HR范围,1.13 [CI,0.78~1.64]~1.43 [CI,0.99~2.08])。使用达比加群的老年患者和肾病患者,胃肠道出血率较高。

局限性:无法考察达比加群剂量结局(匹配患者之间不能接受的协变量平衡)或华法林抗凝质量(使用华法林的患者中,很少能获得国际标准化比值)。

结论:在临床实践中,房颤匹配成人中,使用达比加群与使用华法林的患者的卒中和出血发病率与试验中的结果一致。达比加群与心梗之间的潜在关系需要进行进一步考察。

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    2018-02-05 131****1460

    学习了受益匪浅

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    2018-02-05 Jackie Li

    学习

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