口服抗凝剂在极端体重中的安全性和有效性
J Chin-Hon1, L Davenport2, J Huang3
1NYU Langone Hospital - Long Island, Department of Pharmacy, United States of America; NYU Long Island School of Medicine, United States of America.
Thrombosis research
|September 22, 2023
概括
像阿皮克萨班这样的直接口服抗凝剂 (DOAC) 对患有静脉血栓栓塞 (VTE) 或心房动 (AF) 的体重不足和肥胖患者是安全有效的. 与华法林相比,阿皮克萨班在这个人群中显示了较低的VTE和出血风险.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 血液学 血液学 血液学
背景情况:
- 目前的指导方针建议在患有高体重指数 (BMI) 的患者中使用标准的直接口服抗凝剂 (DOAC) 剂量,但对肥胖或体重不足的人缺乏比较数据.
- 2021年国际血栓与血液静止学会 (ISTH) 的指导方针没有直接将DOAC与肥胖症进行对比,也没有针对体重不足的患者.
研究的目的:
- 评估DOACs与华法林相比在体重不足和肥胖患者中的安全性和有效性.
- 评估这些患者群体中血栓栓塞和出血事件的发生率.
主要方法:
- 对492名接受静脉血栓塞栓症 (VTE) 治疗或心房动 (AF) 治疗的患者进行了回顾性分析.
- 患者被分为四个身体质量指数 (BMI) 组,包括体重不足 (80名患者) 和肥胖 (412名患者).
- 统计分析包括描述性统计数据,克鲁斯卡尔-瓦利斯测试,奇平方测试,费舍尔的精确测试和曼-惠特尼测试,以比较华法林和DOACs (阿皮克萨班,里瓦罗克萨班,达比加特兰) 之间的结果.
主要成果:
- 与华法林 (p=0.0149) 相比,阿皮克萨班在统计学上显示了较低的静脉瘤发病率 (p=0.0149).
- 与华法林相比,阿皮克萨班的整体出血率最低 (p=0.0194).
- 在比较所有DOACs组合与华法林时,没有观察到VTE或出血率的统计学上显著差异.
结论:
- 直接口服抗凝剂 (DOAC),特别是阿皮克萨班,对于需要为VTE和AF抗凝药的体重不足和肥胖患者来说,似乎是安全有效的.
- 在这项研究中,阿皮克萨班与华法林相比,显示出良好的安全性和有效性,与VTE和出血率相比较低.
- 这些发现为在极度体重的人群中使用DOACs,特别是apixaban提供了有价值的临床见解.
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