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J Am Heart Assoc：房颤患者二级预防：直接口服抗凝药vs维生素K拮抗剂

2018-04-26 何娜 环球医学网

房颤患者二级预防口服抗凝药维生素k拮抗剂
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新上市药物在上市后观察性研究完成之前均需进行实时监测。2018年3月，发表在《J Am Heart Assoc》的一项先导研究对直接口服抗凝药vs维生素K拮抗剂用于非瓣膜性房颤二级预防的安全性和有效性进行了近似实时监测。

新上市药物在上市后观察性研究完成之前均需进行实时监测。2018年3月，发表在《J Am Heart Assoc》的一项先导研究对直接口服抗凝药vs维生素K拮抗剂用于非瓣膜性房颤二级预防的安全性和有效性进行了近似实时监测。

背景：新上市药物需进行实时监测直至上市后观察性研究末期。研究者对口服抗凝药实验病例实施了近似实时监测先导方案。研究者于2013~2015年期间在意大利拉齐奥大区评估了直接口服抗凝药vs维生素K拮抗剂用于非瓣膜性房颤二级预防的安全性和有效性。

方法和结果：使用序贯倾向得分匹配新使用者平行队列设计，进行了一项队列研究。使用Cox模型进行了序贯分析。

总体来说，10742例患者用于分析。与维生素K拮抗剂相比，直接口服抗凝药的使用与全因死亡率（0.81；95% CI，0.66~0.99）、心血管死亡率（0.71；0.54~0.93）、心肌梗死（0.67；0.43~1.04）、缺血性卒中（0.87；0.52~1.45）、出血性卒中（0.25；0.07~0.88）降低相关，胃肠道出血没有显着差异（1.26；0.69~2.30）。

结论：本先导研究是该区域建立新药实时监控的基石。

原始出处：

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    2018-11-16 huperzia

    #直接口服抗凝药#

    0

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    2018-04-28 zhaojie88

    #ART#

    0

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time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309539, encodeId=46b930953951, content=感谢小编为我们准备了如此丰盛的精神大餐.同时也向作者致谢!认真学习了.点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Apr 26 19:12:48 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-28 hunizi005

    #口服抗凝药#

    0

  4. 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2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614450, encodeId=fa631614450d8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sat Apr 28 09:18:00 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309653, encodeId=0c9b309653e6, content=不错耶.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Fri Apr 27 06:33:39 CST 2018, time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309539, encodeId=46b930953951, content=感谢小编为我们准备了如此丰盛的精神大餐.同时也向作者致谢!认真学习了.点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Apr 26 19:12:48 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-28 bsmagic9133

    #维生素K#

    0

  5. 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time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309539, encodeId=46b930953951, content=感谢小编为我们准备了如此丰盛的精神大餐.同时也向作者致谢!认真学习了.点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Apr 26 19:12:48 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-28 zhouqu_8

    #维生素k拮抗剂#

    0

  6. 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content=<a href='/topic/show?id=90d75628960' target=_blank style='color:#2F92EE;'>#拮抗剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56289, encryptionId=90d75628960, topicName=拮抗剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=474c10379153, createdName=ms5236388012055669, createdTime=Sat Apr 28 09:18:00 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562895, encodeId=bc5415628953e, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Apr 28 09:18:00 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614450, encodeId=fa631614450d8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sat Apr 28 09:18:00 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309653, encodeId=0c9b309653e6, content=不错耶.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Fri Apr 27 06:33:39 CST 2018, time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309539, encodeId=46b930953951, content=感谢小编为我们准备了如此丰盛的精神大餐.同时也向作者致谢!认真学习了.点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Apr 26 19:12:48 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-28 ms5236388012055669

    #拮抗剂#

    0

  7. 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content=<a href='/topic/show?id=90d75628960' target=_blank style='color:#2F92EE;'>#拮抗剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56289, encryptionId=90d75628960, topicName=拮抗剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=474c10379153, createdName=ms5236388012055669, createdTime=Sat Apr 28 09:18:00 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562895, encodeId=bc5415628953e, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Apr 28 09:18:00 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614450, encodeId=fa631614450d8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sat Apr 28 09:18:00 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309653, encodeId=0c9b309653e6, content=不错耶.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Fri Apr 27 06:33:39 CST 2018, time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309539, encodeId=46b930953951, content=感谢小编为我们准备了如此丰盛的精神大餐.同时也向作者致谢!认真学习了.点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Apr 26 19:12:48 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-28 slcumt

    #HEART#

    0

  8. 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2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614450, encodeId=fa631614450d8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sat Apr 28 09:18:00 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309653, encodeId=0c9b309653e6, content=不错耶.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Fri Apr 27 06:33:39 CST 2018, time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309539, encodeId=46b930953951, content=感谢小编为我们准备了如此丰盛的精神大餐.同时也向作者致谢!认真学习了.点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Apr 26 19:12:48 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-28 hittouch

    #房颤患者#

    0

  9. 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2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614450, encodeId=fa631614450d8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sat Apr 28 09:18:00 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309653, encodeId=0c9b309653e6, content=不错耶.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Fri Apr 27 06:33:39 CST 2018, time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309539, encodeId=46b930953951, content=感谢小编为我们准备了如此丰盛的精神大餐.同时也向作者致谢!认真学习了.点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Apr 26 19:12:48 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-27 owlhealth

    不错耶.学习了

    0

  10. 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2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614450, encodeId=fa631614450d8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sat Apr 28 09:18:00 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309653, encodeId=0c9b309653e6, content=不错耶.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Fri Apr 27 06:33:39 CST 2018, time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309539, encodeId=46b930953951, content=感谢小编为我们准备了如此丰盛的精神大餐.同时也向作者致谢!认真学习了.点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Thu Apr 26 19:12:48 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-26 虈亣靌

    感谢小编为我们准备了如此丰盛的精神大餐.同时也向作者致谢!认真学习了.点赞!

    0

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2017年8月，发表在《J Am Coll Cardiol》的一项由美国科学家进行的研究，考察了房颤患者发生脑淀粉样血管病的诊断、临床意义和管理策略。

Int J Clin Pract:肾功能是否影响使用维生素K拮抗剂的非瓣膜性房颤患者抗凝控制？

2017年，发表在《Int J Clin Pract》的一项由西班牙和英国科学家进行的研究，考察了肾功能对使用维生素K拮抗剂的非瓣膜性房颤（AF）患者抗凝控制的影响。

JACC:抗凝治疗的房颤患者 其肾脏结局如何？

2017年发表在《J Am Coll Cardiol》的一项由美国和加拿大科学家进行的研究考察了抗凝治疗的房颤（AF）患者的肾脏结局。

JACC：房颤患者使用达比加群2年内依从性如何？

2017年9月，发表在《J Am Coll Cardiol》上的一项研究，调查了房颤患者在2年的随访期中对达比加群酯依从性。研究结果显示：2年后，达比加群治疗依从的概率约为70%。近一半停用达比加群的患者转换为另一种口服抗凝药。并且北美患者和具有阵发性、持续性或症状性房颤的患者具有较高的停止达比加群风险。

J Am Heart Assoc：在2014年AHA指南指导下使用OAC的房颤患者结局如何？

2018年1月，发表在《J Am Heart Assoc》的一项由美国科学家进行的研究，考察了在2014年的美国心脏协会(AHA)/美国心脏病学院/心脏节律协会指南下新推荐使用口服抗凝药的房颤患者结局。

Eur Heart J:一箭双雕 房颤患者用抗凝药还能预防痴呆

发表在《欧洲心脏杂志》的一项来自瑞典的回顾性登记注册研究发现，抗凝药还有一种重要作用——预防痴呆症。