在X动脉置换患者接受低剂量华法林和低剂量阿司匹林治疗
Aung Y Oo1, Mahmoud Loubani2, Marc W Gerdisch3
1Department of Cardiovascular Surgery, Bart's Health NHS Trust, London, UK.
概括
华法林针对1.8的较低国际正常化比率 (INR) 与阿司匹林是安全和有效的在X上大动脉机械患者. 这种方法可以显著减少出血事件,而不会增加血栓栓塞的风险.
科学领域:
- 心血管医学 心血管医学
- 医疗器械技术 医疗器械技术
- 药理学 药理学是指药理学的学科.
背景情况:
- 机械动脉置换需要抗凝治疗,以预防血栓栓塞事件.
- 华法林是一种常见的抗凝剂,通常在2.0-3.0的目标国际正常化比率 (INR) 范围内管理.
- 由于其设计,On-X机械大动脉可以承受较低的INR目标.
研究的目的:
- 为了评估华法林的安全性和有效性,在患有上-X大动脉机械的患者中,针对较低的INR为1.8 (范围为1.5-2.0).
- 为了将结果与先前试验中使用的标准剂量华法林 (INR 2.0-3.0) 进行比较.
主要方法:
- 一项前性观察性注册研究,涉及510名患有上X大动脉机械门的患者.
- 患者接受了针对INR1.8 (范围1.5-2.0) 的华法林,以及每天服用阿司匹林 (75-100毫克).
- 主要终点:血栓栓塞,膜血栓和严重出血的复合. 与PROACT试验对照组 (INR 2.0-3.0) 相比.
主要成果:
- 主要复合终点率为每年患者2.31%,与PROACT对照组 (5.39%) 相比减少57%.
- 大型出血减少了85%,总出血减少了73%.
- 没有观察到膜血栓形成的病例. 结果在各个子组 (家庭/诊所监测,高风险患者) 中一致.
结论:
- 针对INR 1.8 (范围1.5-2.0) 的华法林与阿司匹林相结合,对于患有上X动脉动脉机械的患者来说是安全有效的.
- 这种较低的INR目标显著减少了出血并发症.
- 这些发现支持使用这种抗凝血策略,无论INR监测方法如何.
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