低剂量阿皮克萨班或里瓦罗克萨班作为上肢深静脉血栓形成的二次预防
1Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy.
Journal of thrombosis and thrombolysis
|June 21, 2023
概括
低剂量直接口服抗凝剂 (DOACs) 可以安全地延长治疗上肢深静脉血栓塞 (UEDVT) 的患者,持久的风险因素,显示没有复发性血栓塞或出血事件.
科学领域:
- 血管医学 血管医学
- 血液学 血液学 血液学
背景情况:
- 上肢深静脉血栓塞 (UEDVT) 通常需要抗凝药,但最优的持续时间和剂量,特别是对于那些有持续风险因素的人来说,仍然不清楚.
- 目前的指导方针建议至少三个月的抗凝药,通常是用维生素K对抗剂 (VKA) 或直接口服抗凝剂 (DOAC).
- 关于在UEDVT患者中延长抗凝剂和降低DOAC剂量的有限数据存在,这些患者正在进行血栓形成风险或不完全静脉再通道化.
研究的目的:
- 评估降低剂量DOACs在二次UEDVT患者中延长抗凝剂的安全性和有效性,这些患者有持续的血栓风险因素或没有静脉再通道.
主要方法:
- 一项回顾性观察性研究,涉及43名用DOACs治疗的二次UEDVT患者.
- 患者最初在急性阶段 (中位数为4个月) 接受治疗剂量的DOAC.
- 32名患有永久性血栓形成风险或没有再通道的患者转换为低剂量DOAC (阿皮克萨班2.5毫克两次或里瓦罗克萨班每天10毫克).
主要成果:
- 在全剂量DOAC阶段发生了一例血栓复发;在低剂量DOAC时没有观察到复发.
- 在全剂量治疗期间发生了三次轻微的出血并发症;在低剂量DOAC治疗中没有发现出血事件.
- 初步数据表明,低剂量的DOAC在这个UEDVT队列中是安全有效的延长治疗.
结论:
- 降低剂量的DOAC似乎是一种安全有效的选择,用于延长UEDVT患者的抗凝血治疗,这些患者患有持续的血栓风险因素或没有静脉再通道.
- 这些发现支持在随机对照试验中进一步调查,以确认剂量减少的DOACs在管理UEDVT中的作用.
- 这一策略可能有助于在特定的UEDVT患者群体中预防复发事件和出血并发症.
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