晚期心力衰竭中使用左心室辅助装置的阿司匹林和血液相容性事件:ARIES-HM3随机临床试验
Mandeep R Mehra1, Ivan Netuka2, Nir Uriel3
1Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
JAMA
|November 11, 2023
概括
在心力衰竭患者中使用左心室辅助装置 (LVAD) 避免服用阿司匹林是安全的,并减少出血. 这种方法与VKA治疗相结合,显示出与阿司匹林使用的非劣势,并降低了非手术性出血事件.
科学领域:
- 心脏病学
- 医疗器械
- 药理学
背景情况:
- 左心室辅助器 (LVAD) 改善了晚期心力衰竭的结果.
- 在LVAD患者中,非手术性出血是显著的并发症.
- 尽管证据有限,但目前的指导方针经常要求使用阿司匹林治疗.
研究的目的:
- 在完全磁悬浮的LVAD患者中排除阿司匹林在抗血栓治疗方案中的安全性和有效性.
- 确定避免服用阿司匹林是否可以减少出血事件而不会增加血栓塞栓的风险.
主要方法:
- 国际,随机,双盲,安慰剂对照试验,涉及628名完全磁悬浮的LVAD患者.
- 患者接受了VKA治疗加上阿司匹林 (100 mg/ d) 或安慰剂.
- 主要终点:12个月的生存期没有与血液相容性相关的不良事件 (中风,血栓,严重出血,血栓塞栓).
主要成果:
- 避孕药组的无事件生存率显示为非劣 (74%与阿司匹林组的68%相比).
- 避免服用阿司匹林显著减少了非手术性出血事件 (RR 0. 66;P=. 002).
- 没有观察到抗阿司匹林中风或其他血栓塞栓事件的增加.
结论:
- 在LVAD患者治疗中排除阿司匹林是安全有效的.
- 避免服用阿司匹林可以减少出血并发症,但不会影响血栓保护.
- 这一发现支持对LVAD患者进行修订的抗血栓治疗策略.
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