動脈動と外周動脈疾患の患者におけるリバロキサバンとアピキサバンの有効性と安全性
Loubna Dari1,2,3,4, Sarah Beradid2, Joël Constans3
1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 Av. McGill College, Montreal, QC H3A 1Y7, Canada.
European heart journal. Cardiovascular pharmacotherapy
|August 30, 2025
まとめ
リバロキサバは,非弁動脈動脈症と外周動脈疾患の患者で,アピキサバと比較して,四肢イベントと脳卒中のリスクが類似していた. しかし,リバロキサバンは大きな出血のリスクと関連していた.
科学分野:
- 心臓病科
- 薬理学について
- 臨床研究
背景:
- 非弁動脈動 (NVAF) と外周動脈疾患 (PAD) は共同疾患であり,血栓塞栓症および出血のリスクを高めます.
- リバロキサバンやアピキサバンのような経口抗凝固薬 (DOACs) は,NVAFの患者で頻繁に使用されていますが,併発性PADの患者におけるその比較効果と安全性については理解が不足しています.
- この高リスク集団における抗凝固戦略を最適化するために,主要有害な肢体イベント (MALE),脳卒中,全身栓塞 (SE),および主要な出血 (MB) のリスクを評価することが重要です.
研究 の 目的:
- リバロキサバンとアピキサバンの間で,NVAFとPADの患者における主要な不良事象 (MALE),脳卒中,全身栓塞 (SE),および主要な出血 (MB) のリスクを比較する.
- NVAFとPADの両方の患者に対するリバロキサバンとアピキサバンの比較安全性と有効性を評価する.
- PADの高リスクのNVAF患者における抗凝固剤の選択に関する臨床的意思決定を導くために.
主な方法:
- UK Clinical Practice Research Datalinkを利用した集団ベースのコホート研究
- 2013年から2021年の間にリバロキサバンまたはアピキサバンを開始した45歳以上のNVAFおよびPADの患者を含む.
- 傾向スコアの細部層化と重み付けは,混同に対処するために使用されました. 95%信頼区間 (CI) を用いた重量Cox比例危険性モデルによる推定危険性比 (HRs)
主要な成果:
- この研究では,リバロキサバンの新規使用者6170人,アピキサバンの新規使用者9990人が参加した.
- リバロキサバンは,アピキサバンと比較して,MALE (aHR: 1. 20; 95% CI: 0. 87-1. 65) と脳卒中/TIA/SE (aHR: 1. 15; 95% CI: 0. 97-1.36) と類似した割合に関連していた.
- アピキサバンと比較して,リバロキサバンで重度の出血率が有意に高かった (aHR: 1. 55; 95% CI 1. 36 - 1.77).
結論:
- NVAFとPADの患者では,リバロキサバンは,アピキサバンと比較して,MALEと脳卒中/TIA/SEに関して同様の有効性を示しました.
- リバロキサバンは,この高リスク集団において,大きな出血の危険性が高かった.
- これらの結果は,アピキサバンがNVAFとPADの両方の患者にとってより安全な抗凝固剤の選択である可能性があることを示唆しています.
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