JAMA:21岁以下的诱发性静脉血栓栓塞患者抗凝治疗可缩短至6周

2022-01-12 MedSci原创 MedSci原创

在21岁以下的诱发性静脉血栓栓塞患者中,6周抗凝治疗在降低血栓复发风险和出血安全性方面与传统的3个月方案相当,达到非劣效性标准。

抗凝药物治疗静脉血栓起始于20世纪60年代,长期临床证实抗凝治疗对降低静脉血栓栓塞复发风险有益。复发性静脉血栓栓塞包括深静脉血栓(DVT)和肺栓塞—复发性深静脉血栓可增加慢性静脉功能不全(血栓后综合征)的风险,而肺栓塞患者的致死风险极高。静脉血栓栓塞的抗凝治疗涉及血栓复发和出血风险之间的权衡,通常抗凝治疗持续时间长达3个月。近日研究人员考察了在年龄小于21岁的急性诱发静脉血栓栓塞患者中,将抗凝治疗持续时间缩短至6周对患者预后的影响。


2008-2021年,研究人员在5个国家的42个中心招募了417例21岁以下急性诱发静脉血栓患者,排除有既往静脉血栓史人群。对无持续性抗磷脂抗体且血栓在诊断后6周再次成像阴性人群进行随机分组,随机接受为期6周(n=207)或3个月(n=210)的抗凝治疗。主要终点是症状性复发性静脉血栓栓塞和1年内的临床相关出血事件。
297名患者参与研究,年龄最大者为20.9岁,平均年龄仅8.3岁,49%为女性。6周抗凝治疗组和3个月抗凝治疗组的1年累积症状性复发性静脉血栓栓塞率分别为0.66%和0.70%,临床出血事件发生率分别为0.65%和0.70%。基于两组之间复发性静脉血栓栓塞和临床相关出血事件的绝对风险差异,证明了结果的非劣效性。6周抗凝治疗组26%的患者发生不良事件,3个月抗凝治疗组32%的患者发生不良事件;最常见的不良事件是发热(分别为1.9%和3.4%)。


研究认为,在21岁以下的诱发性静脉血栓栓塞患者中,6周抗凝治疗在降低血栓复发风险和出血安全性方面与传统的3个月方案相当,达到非劣效性标准。
原始出处:
Goldenberg et al. Effect of Anticoagulant Therapy for 6 Weeks vs 3 Months on Recurrence and Bleeding Events in Patients Younger Than 21 Years of Age With Provoked Venous Thromboembolism The Kids-DOTT Randomized Clinical Trial. JAMA,January 11, 2022。

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    2022-11-28 fusion
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    2022-08-03 xue8602
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    2022-01-13 630658601

    学习了,非常好

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    2022-01-13 ms1000000721605759

    好文章

    0

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    2022-01-12 ms4000001513304915

    学习#学习#

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    2022-01-12 屋顶瞄爱赏月

    学习了

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