在患有初级中枢神经系统恶性瘤和二次转移的患者中,抗凝剂的处方模式
Emily Abdelmessih1, Tania Ahuja2,3, Stephanie Wo1
1Department of Pharmacy, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA.
Journal of thrombosis and thrombolysis
|January 28, 2024
概括
与低分子量肝素 (LMWH) 相比,直接口服抗凝剂 (DOAC) 在脑瘤患者中显示出内出血 (ICH) 的风险较低. 在这种人群中,DOACs是抗凝血的更安全选择.
科学领域:
- 神经学 神经学
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 患有中枢神经系统 (CNS) 恶性瘤和转移的患者通常需要抗凝药.
- 在这种特定人群中,直接口服抗凝剂 (DOAC) 和低分子量肝素 (LMWH) 的安全概况尚未得到充分确立.
- 在接受抗凝药的脑瘤患者中,内出血 (ICH) 是一个重大问题.
研究的目的:
- 为了比较中枢神经系统恶性瘤和二次转移的患者中DOAC和LMWH之间的ICH发病率.
- 评估二次结果,包括非ICH出血事件和血栓塞栓事件.
- 评估与每个抗凝剂类别相关的耐受性和治疗变化.
主要方法:
- 追溯队列研究,包括2018年至2022年用DOAC或LMWH治疗的中枢神经系统恶性瘤和转移的成年患者.
- 主要结局:在开始抗凝剂后任何ICH的发生率.
- 二次结局:非ICH出血,血栓栓塞事件和抗凝剂治疗的变化. 数据被审查为不朽的时间偏差超过3个月.
主要成果:
- ICH发生在7.7%的患者中,与DOAC (4%;p=0.037) 相比,沙 (LMWH) 组 (16%) 的发病率显著更高.
- 非ICH出血在DOAC组中更常见 (13%) 但主要是轻微的 (p=0.037).
- 血栓塞栓事件在各组之间没有显著差异. 与LMWH相比,更频繁地切换抗凝剂 (37.8%对12.4%;p<0.001).
结论:
- 与低分子量肝素 (LMWH) 相比,直接口服抗凝剂 (DOAC) 与脑瘤或转移患者的脑内出血风险较低有关.
- 在这种高风险患者群体中,DOACs可能比LMWH更适合用于抗凝剂,平衡出血风险和疗效.
- 需要进一步的前性研究来证实这些发现,并优化神经瘤患者的抗凝策略.
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