抗血小板治疗在患有腹腔大动脉动脉瘤但没有症状的动脉样硬化疾病的患者中

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Chalotte W Nicolajsen^1,2,3, Mette Søgaard^1,2, Martin Jensen¹

¹Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.

JAMA network open

|October 25, 2023

概括

抗血小板治疗在减轻腹腔大动脉动脉瘤患者的缺血事件方面没有显著的益处. 该研究表明,可能会增加出血风险的趋势,这表明这种治疗在这个人群中的临床相关性有限.

科学领域:

心血管医学心血管医学
临床流行病学临床流行病学
药理学药理学是指药理学的学科.

背景情况:

患有腹腔大动脉动脉瘤 (AAA) 的患者面临高缺血事件的风险,由于伴随性动脉样硬化心血管疾病.
目前的指导方针建议对AAA患者进行抗血小板治疗,但对没有症状动脉样硬化的患者的益处缺乏研究.

研究的目的:

评估抗血小板治疗在预防患有AAA但没有症状的动脉样硬化血管疾病的个体中缺血事件和出血的疗效.
为临床实践提供基于证据的见解,关于在这个特定的患者群体中使用抗血小板剂.

主要方法:

在丹麦国家卫生登记处数据上使用目标试验模拟的比较有效性研究.
纳入标准:被诊断为AAA且没有症状的动脉样性血管疾病的抗血小板原始患者 (2010-2021年).
评估结果:缺血性事件 (心肌梗塞,缺血性中风) 和严重出血,使用聚合后勤回归分析.

主要成果:

分析包括6,344名患者;3,363人开始抗血小板治疗. 对治疗意图的分析显示,缺血事件没有显著减少 (HR 0.91;95% CI,0.73-1.17)).
在抗血小板治疗中观察到增加出血风险的趋势 (治疗意图HR1.26;95%CI,0.97-1.58).
两组之间事件率的绝对差异很小,这表明临床意义有限.

结论:

抗血小板治疗没有证明在AAA患者和没有症状的动脉样硬化血管疾病患者中降低缺血事件风险的有效性.
发现了潜在的出血风险增加,而抗血小板治疗对这一群体的整体临床相关性似乎有限.
进一步的研究可能是有必要的,但目前的研究结果表明,在AAA患者的这一亚组中,对处方抗血小板药物采取谨慎的方法.

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