Stroke:既往有胃肠道出血的房颤患者非维生素K拮抗剂口服抗凝剂疗效分析

2021-01-16 MedSci原创 MedSci原创

在既往有GIB病史的房颤患者中,与华法林相比,服用NOACs的患者发生缺血性卒中和大出血的风险更低。

支持非维生素K口服抗凝药物(NOACs)对既往有胃肠道出血(GIB)病史的房颤患者具有保护作用的数据十分有限。近日,血管疾病领域权威杂志Stroke上发表了一篇研究文章,研究人员旨在评估既往有GIB病史的房颤患者服用NOACs的有效性和安全性,并与华法林进行比较。

研究人员从韩国索赔数据库中确定了2010年1月至2018年4月期间未接受口服抗凝药治疗的房颤患者,这些患者既往有GIB病史。研究人员采用治疗加权反概率法平衡协变量对NOAC服用者与华法林服用者进行比较。该研究的主要终点为缺血性卒中、大出血和复合终点(缺血性卒中合并大出血)。每个结果中的致命事件作为次要结局进行评估。

该研究共纳入42048例患者(NOAC组24781例,华法林组17267例)。从既往GIB到开始口服抗凝药物的平均时间间隔为3.1±2.6年。在治疗加权逆概率分析后,两组间基线特征平衡(平均年龄为72岁;男性占56.8%;CHA2DS2-VASc平均得分为3.7)。与使用华法林相比,使用NOAC可降低缺血性卒中、大出血和综合预后的风险(加权风险比为0.608 [95%CI为0.543-0.680];风险比为0.731 [95%CI为0.642-0.832];风险比为0.661 [95%CI为0.606-0.721]。对于所有次要结局,与华法林相比,NOACs降低风险的程度更大。

由此可见,在既往有GIB病史的房颤患者中,与华法林相比,服用NOACs的患者发生缺血性卒中和大出血的风险更低

原始出处:

Soonil Kwon.et al.Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Prior Gastrointestinal Bleeding.stroke.2021.https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030761

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    2021-02-14 易水河

    说的不错

    0

  3. 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