NEJM:房颤合并稳定性冠状动脉疾病患者的抗血栓治疗

2019-09-19 xing.T MedSci原创

由此可见,作为抗血栓治疗,房颤合并稳定性冠状动脉疾病患者采用利伐沙班单药治疗其疗效并不劣于联合治疗,其安全性更好。

关于心房颤动和稳定性冠状动脉疾病患者使用抗血栓治疗的随机试验数据十分有限。近日,顶级医学期刊NEJM上发表了一篇研究文章,研究人员在日本进行的一项多中心开放性试验,随机分配了2236例1年前接受过经皮冠状动脉介入治疗(PCI)或冠状动脉旁路移植术(CABG)或血管造影证实冠状动脉疾病不需要血运重建的心房颤动患者,分别接受单用利伐沙班(非维生素K拮抗剂口服抗凝剂)或与利伐沙班加单一抗血小板药联合治疗。

该研究的主要疗效终点是卒中、全身性栓塞、心肌梗塞、需要血运重建的不稳定型心绞痛或任何原因造成死亡的复合事件;对这一终点进行了非劣效性分析,非劣效性界限为1.46。根据国际血栓形成和止血学会的标准,该研究的主要安全终点是大出血;研究人员分析了这一终点的优越性。

由于联合治疗组死亡率增加,该试验提前停止。利伐沙班单药治疗在主要疗效终点方面不劣于联合治疗,事件发生率每患者每年分别为4.14%和5.75%(对于非劣效性风险比为0.72; 95%置信区间[CI]为0.55至0.95; P<0.001)。利伐沙班单药治疗优于联合治疗的主要安全性终点,事件发生率每患者每年分别为1.62%和2.76%(对于优势的风险比为0.59; 95%CI为0.39至0.89;P=0.01)。

由此可见,作为抗血栓治疗,房颤合并稳定性冠状动脉疾病患者采用利伐沙班单药治疗其疗效并不劣于联合治疗,其安全性更好。 

原始出处:

Satoshi Yasuda,et al.Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease.NEJM.2019.https://www.nejm.org/doi/full/10.1056/NEJMoa1904143

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    2019-09-20 gwc388
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    2019-09-19 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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