JAHA:新型口服抗凝剂vs.华法林治疗房颤和瓣膜性心脏病的安全性和疗效

2018-04-12 xiangting MedSci原创

新型口服非维生素K抗凝剂是预防全身血栓安全有效的选择。

这篇文章研究了一个以社区为基础的房颤(AF)和瓣膜性心脏病(VHD)(不包括人工瓣膜)大样本患者队列,旨在比较伴或不伴VHD的AF患者使用华法林、达比加群及利伐沙班的结局。

纳入2011年至2013年参加医疗保险D福利计划并新诊断为AF的医保受益人(其中18137例伴有VHD [达比加群,1979;利伐沙班,2027;华法林,14131],85596例不伴VHD [达比加群,13522;利伐沙班,14257;华法林,57817])。使用3向倾向匹配样本比较了3种抗凝剂的全因死亡率、缺血性中风、主要出血和心梗的主要结局。在倾向匹配后,共研究了5871例伴VHD患者和40221例不伴VHD和AF的患者。达比加群和利伐沙班与VHD伴房颤患者的死亡风险显著降低相关(达比加群vs.华法林:风险比0.71; 95%置信区间0.52-0.98; P= 0.038; 利伐沙班vs.华法林:风险比为0.68; 95%置信区间,0.49-0.95; P = 0.022)。与华法林相比,达比加群和利伐沙班治疗的VHD患者的非胃肠道出血显著降低(达比加群vs.华法林,风险比0.17; 95%置信区间0.06-0.49; P = 0.001;利伐沙班vs.华法林:风险比0.37; 95%间隔,0.17-0.84; P = 0.017)。利伐沙班、达比加群和华法林治疗VHD患者的缺血性卒中和胃肠道出血率无差异。在伴和不伴VHD的AF患者中,3种抗凝剂对结局的影响相当。

在2011至2013年间新发AF的伴VHD的医保受益者队列中(不包括人工瓣膜患者),新型口服非维生素K抗凝剂是预防全身血栓安全有效的选择。

原始出处:

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    2019-02-08 bshuang
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    2018-04-14 zhaohui6731
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    2018-04-12 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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    2018-04-12 131****1460

    学习了受益匪浅

    0

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    2018-04-12 虈亣靌

    不错.学习了.谢谢分享.很好的学习资源

    0

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