Ann Neurol:近期缺血性脑卒中的房颤患者直接口服抗凝剂与维生素K拮抗剂比较

2020-04-07 MedSci原创 MedSci原创

本研究中,我们比较了直接口服抗凝剂(DOACs)和维生素K拮抗剂(VKAs)在房颤(AF)和近期脑缺血患者中的治疗结果。

本研究中,我们比较了直接口服抗凝剂(DOACs)和维生素K拮抗剂(VKAs)在房颤(AF)和近期脑缺血患者中的治疗结果。

 

研究人员对7项前瞻性队列研究进行了个体患者数据分析。纳入了房颤和近期脑缺血的患者(开始口服抗凝治疗前<3个月),最少随访3个月。使用混合效应Cox比例危害因素回归模型分析了抗凝类型(DOAC与VKA)与综合主要终点(复发性脑缺血性卒中[AIS]、脑内出血[ICH]或死亡率)之间的关联;计算了校正后的危害比(HRs),并计算了95%置信区间(95%CI)。

 

研究纳入了4912名患者(年龄中位数78岁[IQR},71-84岁];女性2 331名[47.5%];发病时国家卫生研究院卒中度严重程度量表中位数为5[IQR,2-12]);2256名(45.9%)患者接受了VKA,2656名(54.1%)接受了DOAC。VKA患者从指数事件到开始口服抗凝的中位时间为5天(IQR,2-14),DOACs为5天(IQR,2-11)(P = 0.53)。在5970个患者年的总随访中,有262例急性缺血性脑卒中(AISs;4.4%/年),71例颅内出血(ICHs;1.2%/年),439例死亡(7.4%/年)。与VKA相比,DOAC治疗与综合终点(HR,0.82;95% CI,0.67-1.00;p = 0.05)和ICH(HR,0.42;95% CI,0.24-0. 71;p < 0.01);我们发现复发性AIS的风险(HR,0.91;95% CI,0.70-1.19;p = 0.5)和死亡率(HR,0.83;95% CI,0.68-1.03;p = 0.09)无差异。

 

总之,与VKA相比,DOAC治疗在最近的脑缺血相关的房颤后早期开始,与VKA相比,DOAC治疗与不良临床预后风险降低有关,主要原因是心肌缺血风险降低。

 

原始出处:

 

David J. Seiffge, MD, Maurizio Paciaroni, et al., Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation. Ann Neurol. 2019 Jun; 85(6): 823–834.

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    2020-10-14 yinhl1978
  4. 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  5. 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  6. 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  7. 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topicList=[TopicDto(id=72429, encryptionId=7f9ae242984, topicName=直接口服抗凝剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b9a54798293, createdName=若水124, createdTime=Wed Apr 08 15:15:51 CST 2020, time=2020-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1511755, encodeId=1a321511e5575, 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=28, 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=Wed Apr 08 15:15:51 CST 2020, time=2020-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614547, encodeId=7d25161454eed, 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=28, 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=Wed Apr 08 15:15:51 CST 2020, time=2020-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026616, encodeId=7cc81026616f9, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Tue Apr 07 03:15:51 CST 2020, time=2020-04-07, status=1, ipAttribution=)]
    2020-04-07 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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