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口服抗凝药治疗心房动的八分生儿在整个功能谱的脏功能谱

Andreina Carbone¹, Roberta Bottino², Emilio Attena³

¹Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Napoli, Italy. andr.carbone@gmail.com.

Cardiovascular drugs and therapy

|December 18, 2023

概括

直接口服抗凝剂 (DOAC) 对心房动 (AF) 和功能下降的八岁以上患者是安全有效的. 与维生素K对抗剂 (VKA) 相比,DOACs在这个患者群体中死亡率较低.

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.
腎臟病學 (nephrology) 是一種醫學專業.

背景情况:

心房动 (AF) 在老年人中很常见,通常与慢性病 (CKD) 并存.
口服抗凝剂 (OAC) 对于AF患者的中风预防至关重要,但其在八岁以上的不同功能患者的使用需要仔细考虑.
直接口服抗凝剂 (DOAC) 和维生素K抗剂 (VKA) 是主要的OAC选择,每种药物在患有功能障碍的老年人群中都具有不同的疗效和安全性.

研究的目的:

评估OACs的疗效和安全性,特别是DOACs与VKAs,在被诊断为AF的八十岁以上 (年龄≥80岁) 人群中.
分析不同功能水平的OAC结果,按肌素清除量 (CrCl) ≥45mL/min/1.73m2和<45mL/min/1.73m2.2进行分类.
为了确定与高风险患者队列中死亡率相关的因素.

主要方法:

来自AF研究数据库 (NCT03760874) 的901名80岁以上的AF患者的回顾性分析.
患者接受了DOAC (n=629) 或VKA (n=272) 的治疗,并以CrCl分层:≥45mL/min/1.73m2 (n=598) 或<45mL/min/1.73m2 (n=303).
主要结局包括主要出血事件 (安全性) 和血栓塞栓事件 (有效性). 还评估了死亡率和特定出血事件,如内出血 (ICH). 多变量回归被用于关联分析.

主要成果:

在功能组中,在DOAC和VKA之间没有观察到重大出血或血栓栓塞发事件的显著差异.
在CrCl<45mL/min/1.73m2的患者中,与DOAC (15%) 相比,VKAs (45%) 的死亡率明显高于DOAC (15%).
在CrCl≥45mL/min/1.73m2的患者中,DOAC与VKA相比,与较少的ICH (0.2%对2.8%) 和较低的死亡率 (7.9%对29.1%) 相关. 年龄和冠状动脉疾病与较高的死亡率有关,而DOAC使用与功能组的死亡率相反相关.

结论:

DOACs在八十多岁的AF和CKD阶段≥G3b (CrCl <45mL/min/1.73m2) 的八十多岁患者中证明了安全性和有效性.
与VKAs相比,DOAC的使用与老年AF患者的功能障碍的死亡率降低有关.
DOACs代表了80多岁的AF和不同程度的功能障碍患者的有利OAC选择,特别是在功能下降的患者中.

关键词:

这是一种抗凝血药物.心房动是一种心房动.慢性脏疾病慢性脏疾病年长的老人.预防中风预防中风

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