中长期和长期的功能变化与直接口服抗凝剂在老年患者与心房动
Giuseppe Armentaro1, Graziella D'Arrigo2, Mario Bo3
1Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy.
Frontiers in pharmacology
|July 20, 2023
概括
与华法林类药物 (WLDs) 相比,接受直接口服抗凝剂 (DOACs) 的心房 (AF) 的老年患者经历了较慢的功能下降. 这项研究强调了DOAC作为AF慢性病患者潜在的节省选择.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 心房动 (AF) 和慢性病 (CKD) 是老年人群中常见的并发症.
- 华法林类药物 (WLDs) 可能会对估计的淋巴细胞过率 (eGFR) 产生负面影响,但与直接口服抗凝剂 (DOACs) 相比,长期影响尚未得到充分证实.
研究的目的:
- 为了比较DOACs与WLDs对AF老年患者功能的中长期影响.
- 调查AF患者的eGFR下降率,这些患者接受了DOAC或WLD治疗.
主要方法:
- 分析了420名老年AF患者 (平均年龄为77.0岁) 的队列,其中136名在WLD和284名在DOAC.
- 在4.9年的中位随访期间,进行了三次eGFR测量.
- 使用线性混合模型和基于组的轨迹模型来评估治疗组之间的eGFR下降差异.
主要成果:
- 在随访期间,整体eGFR显著下降,从67.4至47.1毫升/分钟/1.73平方米 (p < 0.001).
- 与WLD患者 (-45.1%) 相比,DOAC患者的eGFR下降幅度明显较小 (-21.3%),而WLD患者的 eGFR下降幅度明显较小 (p < 0.001).
- 随着时间的推移,DOAC与属于不太明显的eGFR下降轨迹的可能性增加了3.03至4.24倍.
结论:
- 接受DOAC治疗的老年AF患者的功能下降速度较慢,与WLD患者相比.
- 在老年AF患者中,DOAC可能会提供节约优势,特别是那些同时患有CKD的患者.
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