Circulation:抗血小板+抗凝对糖尿病合并心血管疾病患者的联合疗效

2020-06-12 QQY MedSci原创

冠状动脉疾病或外周动脉疾病患者通常合并糖尿病。这类患者未来发生血管事件的风险很高。

冠状动脉疾病或外周动脉疾病患者通常合并糖尿病。这类患者未来发生血管事件的风险很高。

本文是COMPASS试验(评估采用抗凝治疗的患者的心血管预后)的预分析,对比了利伐沙班(2.5 mg,2/日)联合阿司匹林(100 mg/日) vs 安慰剂联合阿司匹林用于糖尿病患者 vs 无糖尿病的患者预防大血管事件的效果。主要疗效评估指标是心血管死亡、心肌梗死卒中的复合结局。次要结点包括全因死亡率和所有的大血管事件(心血管死亡率、心肌梗死、卒中或重大的肢体不良事件[包括截肢])。主要安全终点是对大出血的国际血栓形成和止血协会标准的校正。

总研究共纳入了10341位合并糖尿病和17054位无糖尿病的患者。对于主要的疗效终点和全因死亡率,有无糖尿病的患者采用利伐沙班联合阿司匹林或安慰剂联合阿司匹林的相对风险降低情况无明显差异。虽然合并糖尿病的患者的绝对风险降低幅度看起来比无糖尿病的患者的大(3年时的主要疗效终点 2.4% vs 1.4%[p<0.0001],全因死亡率 1.9% vs 0.6%[p=0.02],大血管事件 2.7% vs 1.7%[p<0.0001]),但两个亚组获益相似。由于有无合并糖尿病的患者的出血风险相似,因此,在本次分析中,利伐沙班的净收益似乎对糖尿病患者更有效。

对于稳定性动脉粥样硬化患者,无论有无合并糖尿病,均可从阿司匹林+利伐沙班治疗中获得相同程度的冠状动脉、脑血管和外周血管的保护作用。鉴于合并糖尿病的患者的基础风险更高,他们的绝对获益其实更大,包括全因死亡率。

原始出处:

Deepak L. Bhatt,et al. Role of Combination Antiplatelet and Anticoagulation Therapy in Diabetes Mellitus and Cardiovascular Disease. Circulation. 2020;141:1841–1854

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    2020-06-12 内科新手

    谢谢梅斯提供这么好的信息,学到很多

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    2020-06-12 misszhang

    谢谢MedSci提供最新的资讯

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