Stroke:利伐沙班和华法林治疗的房颤患者卒中和死亡的风险

2020-01-02 xing.T MedSci原创

由此可见,初步诊断为房颤后,利伐沙班和华法林治疗的患者卒中风险显著降低,尤其是严重卒中和卒中后全因死亡率。这项观察性研究的结果可能有助于为非瓣膜性房颤患者卒中预防选择合适的抗凝药物。

口服抗凝治疗是非瓣膜性房颤患者预防卒中的标准治疗方法。近日,心血管疾病领域权威杂志Stroke上发表了一篇研究文章,这项研究比较了利伐沙班和华法林在现实环境中降低卒中和全因死亡率的风险。

这项回顾性队列研究(2011-2017年)纳入了来自Optic Clinformatics数据库的患者,这些患者在初步诊断为非瓣膜性房颤后30天内开始服用利伐沙班或华法林进行治疗。在诊断非瓣膜性房颤之前,患者已连续6个月进行健康招募且CHA2DS2-VASc评分≥2。卒中的严重程度由美国国立卫生研究院卒中量表确定,该量表是根据机器学习算法估算的。研究人员通过使用Cox比例风险回归比较了卒中和全因死亡率风险,并通过权重加权的概率,以平衡队列的基线危险因素。研究人员还按治疗持续时间进行了分层分析。

在平均27个月的随访期间中,有175名(1.33/100名患者每年[PY])接受利伐沙班治疗和536名(1.66/100 PY)接受华法林治疗的患者发生了卒中。治疗加权模型的逆概率表明,利伐沙班将卒中风险降低了19%(风险比[HR],0.81 [95%CI,0.73-0.91])。通过对卒中严重程度的分析显示,对于严重卒中(美国国立卫生研究院中风量表评分为16-42; HR为0.52 [95%CI,0.33-0.82]),利伐沙班降低了48%的风险;对于轻微卒中(美国国立卫生研究院评分为1-5HR为0.81 [95%CI,0.68–0.96]),降低了19%;但中度卒中没有差异(美国国立卫生研究院卒中量表评分为5-16; HR为0.93 [95%CI,0.78–1.10])。利伐沙班治疗的41例(0.31/100 PY)和华法林治疗的147例(0.44/100 PY)患者死于卒中后,其中30天内死亡的患者分别有12例(0.09/100 PY)和67例(0.20/100 PY),表示在30天内,利伐沙班降低了卒中后死亡24%(HR为0.76 [95%CI,0.61-0.95])和30天内59%(HR为0.41 [95%CI,0.28–0.60])的风险。

由此可见,初步诊断为房颤后,利伐沙班和华法林治疗的患者卒中风险显著降低,尤其是严重卒中和卒中后全因死亡率。这项观察性研究的结果可能有助于为非瓣膜性房颤患者卒中预防选择合适的抗凝药物。

原始出处:

Mark Alberts.et al.Risks of Stroke and Mortality in Atrial Fibrillation Patients Treated With Rivaroxaban and Warfarin.stroke.2019.https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.025554

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    2021-01-06 ms1000000737789139

    学习了

    0

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    2020-09-14 辣妈

    学习了

    0

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    2020-01-02 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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    2020-01-02 心介

    房颤,临床上碰到很多哦

    0

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