在COMPASS试验中的中风结果
Mukul Sharma1, Robert G Hart1, Stuart J Connolly1
1McMaster University/Population Health Research Institute, Hamilton, Canada (M.S., R.G.H., S.J.C., J.B., O.S., K.K.H.N., L.C., S.Y., J.W.E.).
Circulation
|January 23, 2019
概括
与单独服用阿司匹林相比,利瓦罗克萨班与阿司匹林的联合治疗显著减少了动脉样硬化患者的中风. 这种联合治疗为预防中风提供了一种新的抗血栓治疗策略.
科学领域:
- 心血管医学
- 药理学
- 神经学
背景情况:
- 在COMPASS试验中,研究了稳定冠状动脉或外周动脉疾病的患者的抗血栓策略.
- 减轻中风是该试验的一个关键结果.
- 之前的分析显示,与单独的阿司匹林相比,里瓦罗克萨班加阿司匹林的益处显著.
研究的目的:
- 从COMPASS试验中详细分析中风的类型,预测因素和抗血栓作用.
- 在预防不同类型的中风方面,评估里瓦罗克萨班加阿司匹林与单独阿司匹林的疗效.
- 在已确定的动脉样硬化病患者中确定中风的独立预测因子.
主要方法:
- 一个随机试验,涉及稳定冠状动脉或外周动脉疾病的患者.
- 三个治疗组:阿司匹林每天一次100毫克,里瓦洛克萨班每天两次5毫克和里瓦洛克萨班每天两次2.5毫克加上阿司匹林.
- 排除标准包括需要抗凝剂,最近的中风,有史以来的性中风或脑内出血.
主要成果:
- 与单独服用阿司匹林相比,阿司匹林与里瓦罗克萨班的联合治疗显著降低了整体中风发生率 (HR,0. 58;P< 0. 0001).
- 通过联合治疗,缺血性/ 不确定的中风减少了近一半 (HR,0. 51; P< 0. 0001).
- 致命性和致残性中风也因该组合而减少 (HR,0. 58;P=0. 01).
- 之前的中风是发生中风的最强独立预测因素 (HR,3. 63; P< 0. 0001).
- 这种组合的益处在所有高风险的中风小组中一致,包括先前患有中风的人.
结论:
- 低剂量里瓦罗克萨班加上阿司匹林在抗血栓治疗中具有显著的进步.
- 这种组合是临床动脉样硬化患者初级和二级中风预防的有效选择.
- 这些发现支持在特定患有中风风险的患者群体中使用利瓦罗克萨班加阿司匹林.
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