Stroke: 非瓣膜性心房颤动患者口服抗凝剂的有效性和安全性研究

2018-12-16 MedSci MedSci原创

目前学界对于口服非维生素K拮抗剂(NOACs)或华法林来治疗非瓣膜性心房颤动患者的卒中/全身栓塞(SE)和大出血(MB)的效果还存在一定争议,因此,本项研究就此展开了相关研究。

背景和目的
目前学界对于口服非维生素K拮抗剂(NOACs)或华法林来治疗非瓣膜性心房颤动患者的卒中/全身栓塞(SE)和大出血(MB)的效果还存在一定争议,因此,本项研究就此展开了相关研究。

方法
研究人员收集了2013年1月1日至2015年9月30日间口服阿哌沙班,达比加群,利伐沙班或华法林治疗的非瓣膜性心房颤动患者的回顾性观察研究。所有患者按1:1的NOAC-华法林和NOAC-NOAC比例倾向得分匹配后,进行了相关统计学分析。Cox模型用于评估匹配队列中卒中/ SE和MB的风险。

结果
共有285292名患者被纳入6个匹配的队列:57929 名apixaban-warfarin队列,26838 名dabigatran-warfarin队列,83007名rivaroxaban-warfarin队列,27096名apixaban-dabigatran队列,62619名apixaban-rivaroxaban队列,和27538 名dabigatran-rivaroxaban队列。与华法林相比,阿哌沙班(风险比[HR],0.61; 95%CI,0.54-0.69),达比加群(HR,0.80; 95%CI,0.68-0.94)和利伐沙班(HR,0.75; 95%CI,0.69-0.82)卒中/ SE发生率较低。阿哌沙班(HR,0.58; 95%CI,0.54-0.62)和达比加群(HR,0.73; 95%CI,0.66-0.81)具有较低的MB风险和利伐沙班(HR,1.07; 95%CI,1.02-1.13)与华法林相比,MB的发生率更高。

结论 
这是一项迄今为止关于NOAC和华法林的最大观察性研究,NOACs的卒中/ SE发生率较低。这项研究的结果可能有助于为医疗服务提供者和非瓣膜性心房颤动患者之间的卒中预防提供新的治疗思路。

原始出处:

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    2019-05-12 bshuang
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    2018-12-18 sodoo

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