Stroke:新型口服抗凝药增加缺血性卒中风险?

2019-01-06 吴星 环球医学

控制房颤的新型口服抗凝药(NOACs)使用增加,在很大程度上受到NOACs在预防缺血性卒中的效果与华法林一样有效,同时患者的出血风险较小这个假设的驱动。2018年12月,发表在《Stroke》的一项回顾性研究比较了华法林和NOACs的卒中发生风险。

控制房颤的新型口服抗凝药(NOACs)使用增加,在很大程度上受到NOACs在预防缺血性卒中的效果与华法林一样有效,同时患者的出血风险较小这个假设的驱动。2018年12月,发表在《Stroke》的一项回顾性研究比较了华法林和NOACs的卒中发生风险。

目的:通过回顾性研究比较使用NOACs的患者与使用华法林的患者之间的卒中相对发生率。

方法:使用比值比和Fisher精确检验来比较71365例使用NOACs的患者和59546例使用华发林的患者的卒中发生率。此外,将7033例既使用过华法林又使用过NOACs的患者作为单独的队列进行分析。

结果:与使用华法林相比,使用NOACs患者的缺血性卒中的发生率显着较高(比值比=1.29,P<0.001)。各NOAC相关的缺血性卒中发生率也较华法林更高(其中,达比加群和阿哌沙班与华法林的差异具有统计学意义,但依度沙班和利伐沙班与华法林的差异没有统计学意义)。使用NOACs的患者的颅内出血和非创伤性出血的发生率较低,与发表的文献结果相一致。研究进一步比较了使用NOACs患者和使用华法林患者的人口统计学和临床特征,结果并未显示NOACs组的患者的基线卒中风险更高;事实上,NOACs组患者的缺血性卒中基线总风险反而更低。

结论:由于与华法林相比,NOAC的使用与较高的缺血性卒中风险和较低的出血风险相关,可以总结出华法林的抗凝效果更强。本研究观察到的结果可能是华法林剂量控制所带来的,也可能是各抗凝药间真实的效果差异。

原始出处:

Shpak M, Ramakrishnan A, Nadasdy Z, et al. Higher Incidence of Ischemic Stroke in Patients Taking Novel Oral Anticoagulants. Stroke. 2018 Dec;49(12):2851-2856. doi: 10.1161/STROKEAHA.118.022636.

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    2019-01-06 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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    2019-01-06 guging

    中风是俗称,应该称为缺血性卒中吧

    0

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    2019-01-06 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

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