JAMA:在肝素治疗基础上添加P2Y12抑制剂对改善新冠肺炎住院患者预后无益

2022-01-19 MedSci原创 MedSci原创

对于非危重新冠肺炎住院患者,在治疗剂量肝素基础上添加P2Y12抑制剂不会改善患者预后,反而会增加患者大出血风险。

COVID-19大流行为全球医疗卫生体系带了前所未有的挑战。虽然大多数住院患者没有危重症,也不需要重症监护级别的医疗支持,但多项随机临床试验显示,24%的非危重患者在接受了治疗剂量的肝素后死亡或接受了重症监护治疗,而凝血功能异常在危重新冠肺炎患者中更为常见,这提示新冠肺炎危重患者需要新的治疗方法。近日研究人员在Covid-19住院的非危重症患者中,考察了在抗凝治疗中添加P2Y12抑制剂的益处和风险。


本次研究在巴西、意大利、西班牙以及美国60家医院开展,562名非危重新冠肺炎住院患者参与,在治疗剂量的肝素基础上,随机接受P2Y12抑制剂(替卡格雷或氯吡格雷,n=293)或安慰剂(n=269),持续14天或患者出院。研究的主要终点为无器官支持天数,主要安全终点是28天的大出血。
患者平均年龄52.7岁,女性占41.5%,87%的患者接受了肝素治疗。在P2Y12组,63%的患者接受了替卡格雷,37%接受了氯吡格雷。P2Y12组平均无器官支持治疗的天数为21天(范围20-21),对照组为21天(范围21-22天),调整后OR=0.83,干预无效率为96%。P2Y12组2%的患者出现大出血,而安慰剂组大出血率为0.7%,风险比为3.31。


研究认为,对于非危重新冠肺炎住院患者,在治疗剂量肝素基础上添加P2Y12抑制剂不会改善患者预后,反而会增加患者大出血风险。
原始出处:
Jeffrey S. Berger et al.Effect of P2Y12 Inhibitors on Survival Free of Organ Support Among Non–Critically Ill Hospitalized Patients With COVID-19 A Randomized Clinical Trial. JAMA,January 18, 2022。

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    2022-08-25 jklm09
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    2023-01-04 yeye5224612
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    2022-01-19 燕子漫飞

    学习了

    0

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    2022-01-19 robbert123

    学习

    0

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BMJ:肝素治疗可降低D二聚体水平升高的中度新冠肺炎住院患者死亡风险

在中度Covid-19住院且伴有D-二聚体水平升高的患者中,接受治疗性肝素治疗可降低患者28天死亡风险,且出血风险较低

BMJ:预防性抗凝治疗可降低新冠肺炎住院患者死亡风险

对于需住院治疗的新冠肺炎患者,接受预防性抗凝治疗可降低30天死亡风险,并且不增加严重出血事件风险

Burns Trauma:严重热损伤中的肝素抵抗:一项前瞻性队列研究

低分子量肝素(LMWH)常规用于烧伤患者以预防血栓形成。临床上将定义为AFXa活性<0.2 IU/ml定义为肝素抵抗,这一现象在严重烧伤患者中非常普遍 (>70%)。一些研究报告了肝素耐药