JAMA Cardiol:合并房颤的稳定型冠状动脉疾病患者采用利伐沙班单药抗凝治疗足矣

2022-06-22 MedSci原创 MedSci原创

与利伐沙班联合抗血小板治疗相比,利伐沙班单药治疗与合并房颤的稳定型冠状动脉疾病患者更低的总血栓和/或出血事件风险更低相关

目前,心房颤动(AF)合并冠状动脉疾病(CAD)的患者的最佳抗血栓治疗尚不明确。与抗凝剂和抗血小板药联合治疗相比,在房颤合并稳定型CAD患者中,利伐沙班单药治疗对总心血管和/或出血事件发生率的影响也尚不清楚。

近期发表在“JAMA Cardiol”上的一项研究,比较了采用利伐沙班单药治疗与利伐沙班联合抗血小板治疗的此类患者的血栓形成和/或出血事件的发生情况。

该研究是一项开放标签的随机临床试验,招募了入组1年前接受过经皮冠脉介入治疗或冠状动脉旁路移植或经血管造影证实CAD但不需要血运重建的合并AF的稳定型CAD患者,予以利伐沙班单药治疗或利伐沙班+抗血小板治疗。主要终点血栓形成、出血和致死性事件的总发生率。


两组的总事件发生率

共有2215位患者(平均74岁,1751位男性)被纳入调整的意向治疗人群分析。中位随访了24.1个月,利伐沙班单药组和联合治疗组的总事件发生率分别是12.2%和19.2%利伐沙班单药组和联合治疗组的死亡率分别是3.7%和6.6%。与联合治疗相比,利伐沙班单药治疗与更低的总事件风险相关(HR 0.62,p<0.001)。与联合治疗相比,单药治疗还是后续事件风险更低的独立因素。出血事件后的死亡风险(单药组 75%,联合组 62.1%)高于血栓形成事件后的死亡风险(25%,37.9%)。


两组首次和后续各事件的发生次数

综上所述,与利伐沙班联合抗血小板治疗相比,利伐沙班单药治疗与合并房颤的稳定型冠状动脉疾病患者更低的总血栓和/或出血事件风险更低相关。因此,在这些患者中应考虑使用单一抗凝剂进行渐进式抗血栓治疗。

 

原始出处:

Naito R, Miyauchi K, Yasuda S, et al. Rivaroxaban Monotherapy vs Combination Therapy With Antiplatelets on Total Thrombotic and Bleeding Events in Atrial Fibrillation With Stable Coronary Artery Disease: A Post Hoc Secondary Analysis of the AFIRE Trial. JAMA Cardiol. Published online June 15, 2022. doi:10.1001/jamacardio.2022.1561.

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    2022-06-25 forvalen

    期待更多对比,越简单越好

    0

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    2022-06-22 肿瘤克星

    JAMA上文章都是顶级的,谢谢梅斯及时上新

    0

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