JAHA:房颤和主动脉瓣狭窄患者接受NOAC与华法林治疗的疗效和安全性分析

2021-11-25 MedSci原创 MedSci原创

研究人员观察到,与华法林相比,使用NOAC治疗的AF和主动脉瓣狭窄患者血栓栓塞风险更高,但大出血风险更低。这一观察结果需要在这些常见患者的大型随机试验中进一步验证。

心房颤动(AF)和瓣膜性心脏病(VHD)经常并存,主动脉瓣狭窄是发达国家最常见的VHD亚型之一,影响很大比例的老年人。狭窄和AF随着年龄的增长而增加,随着人口老龄化而迅速增加,被诊断为主动脉瓣狭窄和AF的患者数量将显著增加。大约16%至36%的主动脉瓣狭窄患者同时伴有AF,并且这些患者中的大多数都在终生接受口服抗凝治疗以预防血栓形成。

关于在主动脉瓣狭窄的AF患者中使用非维生素K拮抗剂口服抗凝剂(NOAC)的指南推荐是基于纳入了少数主动脉瓣狭窄患者的研究。近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,该研究的目的是评估NOAC与华法林对伴有主动脉瓣狭窄的AF患者血栓栓塞和大出血的影响。

研究人员使用2013年至2018年丹麦全国登记处的观察数据模拟了一项目标试验。血栓栓塞定义为缺血性卒中和/或全身性栓塞的医院诊断,而大出血定义为颅内出血、胃肠道出血或其他解剖部位的严重或临床相关出血。治疗效果估计基于意向治疗和符合方案的方法。

该研究共有3726名AF和主动脉瓣狭窄患者接受了NOAC(2357名患者)或华法林(1369名患者)治疗处方,并符合试验的标准。在3年的随访期间,在意向治疗分析中,与华法林相比,NOAC治疗患者的血栓栓塞和大出血的调整风险比分别为1.62(95%CI为1.08-2.45)和0.73(0.59-0.91)。在符合方案的分析中观察到了类似的结果。

在这项观察性研究中,研究人员观察到,与华法林相比,使用NOAC治疗的AF和主动脉瓣狭窄患者血栓栓塞风险更高,但大出血风险更低。这一观察结果需要在这些常见患者的大型随机试验中进一步验证。

原始出处:

Line Melgaard,et al.Effectiveness and Safety of NOAC Versus Warfarin in Patients With Atrial Fibrillation and Aortic Stenosis.JAHA.2021.https://www.ahajournals.org/doi/10.1161/JAHA.121.022628

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    2021-11-27 zhaohui6731
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    2021-11-26 junebenf

    学习了

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