在心房动中使用抗凝剂. 一个大型的现实世界更新
Mario Bo1, Stefano Fumagalli2, Luca Degli Esposti3
1Section of Geriatrics, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, Molinette, Turin, Italy.
European journal of internal medicine
|October 25, 2023
概括
直接口服抗凝剂 (DOAC) 在非膜动 (NVAF) 患者中显示出比维生素K对抗剂 (VKA) 更好的临床净益处. 许多NVAF患者仍在接受不适当的治疗,这凸显了改善抗凝血教育的必要性.
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.
- 公共卫生 公共卫生
背景情况:
- 在非膜心肌动 (NVAF) 患者口服抗凝剂治疗 (OAT) 影响的分析,使用意大利大型全国性行政数据库.
- 由于NVAF影响了人口的很大一部分,因此需要有效的抗血栓策略.
研究的目的:
- 评估不同抗血栓治疗在OAT-naïve NVAF患者中的比较有效性和安全性.
- 在现实环境中识别不适当的抗凝剂的程度.
主要方法:
- 对170,404名OAT-naiveNVAF患者的倾向性得分匹配分析.
- 包括缺血性中风 (IS),全身栓塞 (SE),内出血 (ICH),大出血 (MB) 和所有原因死亡率在治疗组中的结果的比较:直接口服抗凝剂 (DOACs),维生素K对抗剂 (VKAs),阿司匹林 (ASA) 和没有治疗 (No Tx).
主要成果:
- 在缺血事件方面,DOACs表现出与VKAs相似的或略高于VKAs的安全概况,但VKAs与较高的ICH发病率,重大出血和死亡率有关.
- 与DOAC和VKA相比,阿司匹林和无治疗组的IS,IS/SE和死亡率显著更高.
- 很大一部分NVAF患者 (38.9%) 没有被处方DOAC或VKA,这表明潜在的治疗不足或不适当的治疗选择.
结论:
- 与VKAs相比,DOAC在NVAF患者中提供了更好的临床净益.
- 该研究强调了NVAF中不适当的抗凝血的重要问题,强调了对医疗保健提供者和患者加强教育计划的必要性.
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