根据年龄的抗血栓策略:来自AUGUSTUS试验的见解
Patricia O Guimarães1, Renato D Lopes2, Daniel M Wojdyla2
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Hospital Israelita Albert Einstein, São Paulo-SP, Brazil.
The American journal of medicine
|June 14, 2024
概括
阿皮克萨班可以降低患有急性冠状动脉综合征的心房患者的出血风险,尤其是老年人. 阿司匹林增加了所有年龄段的出血风险. 考虑阿皮克萨班加P2Y12抑制剂,避免阿司匹林,对于这些患者.
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.
- 老年病的医生 老年病的医生
背景情况:
- 患有急性冠状动脉综合征 (ACS) 或皮肤冠状动脉干预 (PCI) 的心房 (AF) 患者需要抗血栓治疗.
- 平衡缺血和出血风险至关重要,特别是在老年患者中.
研究的目的:
- 评估AF患者的抗血栓策略的特定年龄的安全性和有效性,这些患者患有ACS和/或PCI.
- 为了在不同年龄组中比较阿皮克萨班与维生素K抗剂 (VKA) 和阿司匹林与安慰剂.
主要方法:
- 对AUGUSTUS试验数据的分析,将4614名患者分为以下年龄组:<65,65-74岁和≥75岁.
- 考克斯模型评估了治疗对重大/临床相关的非重大出血,重大出血,死亡/再住院和缺血事件的影响.
主要成果:
- 在所有年龄组中,阿皮克萨班显示出比VKA更低的出血率,老年患者的绝对减少更大.
- 与安慰剂相比,阿司匹林在所有年龄层显著增加了出血风险.
- 不管年龄,在阿皮克萨班/VKA和阿司匹林/安慰剂组之间,缺血事件率和死亡/再住院情况相似.
结论:
- 与VKA相比,阿皮克萨班在患有ACS/PCI的AF患者中提供了有利的出血概况,特别有利于老年人.
- 由于增加出血风险,应避免服用阿司匹林,而不会改善这种人群的缺血性结果.
- 这些发现支持阿皮克萨班加上一个P2Y12抑制剂,省略阿司匹林,对于所有年龄组的近期ACS/PCI的AF患者.
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