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心不全および慢性冠動脈または外周動脈疾患患者のリバロキサバンとアスピリン
Kelley R Branch1, Jeffrey L Probstfield1, John W Eikelboom2
1Cardiology Division, University of Washington, Seattle (K.R.B., J.L.P., R.K.C.).
Circulation
|June 6, 2019
PubMed で要約を見る
まとめ
リバロキサバンとアスピリンは,心臓機能不全 (HF) と冠動脈疾患または外周動脈疾患を有する患者の主要な心血管不良を有意に軽減し,HFのない患者よりも絶対的な利点を提供しました.
科学分野:
- 心血管医学
- 薬理学について
- 臨床試験
背景:
- 慢性冠動脈疾患 (CAD) または外周動脈疾患 (PAD) と心臓不全 (HF) の病歴を有する患者は,重大な心血管疾患 (MACE) のリスクが高くなります.
- この高リスク集団におけるリバロキサバンとアスピリンの有効性と安全性の調査は,治療戦略を最適化するために極めて重要です.
研究 の 目的:
- リバロキサバンとアスピリンの併用または単独でMACEおよび重度の出血を評価するために,CADまたはPADの患者およびHFの履歴.
- 心不全の存在と重症度に基づいて治療効果を比較する (エジェクション分数 < 40% 対 ≥ 40%).
主な方法:
- この研究では,リバロキサバンとアスピリン,リバロキサバン単独,またはアスピリン単独に 27,395人をランダムに割り当てた COMPASS 試験のデータを分析した.
- 小グループ分析は,HFの既往と既往の患者で実施し,発射分数 (EF) < 40% または ≥ 40% で分層化しました.
- 主なアウトカムには,MACE (心血管疾患による死亡,脳卒中,心筋梗塞) と大出血が含まれていた.
主要な成果:
- リバロキサバンとアスピリンは,HF (HR 0. 68) とHF (HR 0. 79) の患者では,アスピリンの単独投与と比較して,MACEにおける類似の相対リスク低下を示したが,HF患者ではより大きな絶対リスク低下を示した (2. 4%対1. 0%).
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