患有高或低出血风险的心房的患者的阿皮克萨班与里瓦罗克萨班:基于人口的队列研究
Mohammed Shurrab1, Peter C Austin2, Cynthia A Jackevicius3
1Cardiology Department, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada; Health Sciences North Research Institute, Sudbury, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto and North, Ontario, Canada; Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
与里瓦洛克萨班相比,阿皮克萨班显著减少了老年心房患者的严重出血,无论出血风险如何. 在直接口服抗凝剂之间没有观察到血栓栓塞事件的差异.
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.
- 公共卫生 公共卫生
背景情况:
- 有限的数据存在于直接口服抗凝剂 (DOAC) 出血率在心房动 (AF) 患者的不同出血风险概况.
- 许多AF患者患有出血风险增加,因此需要对DOAC进行比较的安全数据.
研究的目的:
- 为了在AF患者中比较阿皮克萨班和里瓦罗克萨班之间的重大出血和血栓塞栓事件风险.
- 根据患者出血风险得分 (HAS-BLED) 来分层这些风险.
主要方法:
- 一个回顾性,基于人口的队列研究在安大略省,加拿大 (2011-2020).
- 包括66岁以上的AF患者接受了apixaban或rivaroxaban治疗.
- 使用HAS-BLED评分 (≥3定义为高风险) 评估出血风险;通过治疗权重的逆概率对并发症进行调整的结果.
主要成果:
- 在高风险 (每年2.9%对4.2%) 和低风险 (每年1.8%对2.9%) AF患者中,阿皮克萨班与较低的重大出血率有关,而非里瓦罗克萨班.
- 在风险组中,在阿皮克萨班和里瓦罗克萨班之间没有发现血栓栓塞事件发生率的显著差异.
- 在高出血风险患者 (63%) 和低风险患者 (56%) 中,阿皮克萨班更频繁地使用.
结论:
- 与老年AF患者的里瓦罗克萨班相比,阿皮克萨班在重大出血方面显示出更高的安全性.
- 这种益处在高和低出血风险层中一致.
- 与阿皮克萨班相比,没有观察到对疗效 (血栓栓塞事件的预防) 的妥协.
相关概念视频
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Anticoagulant Drugs: Low-Molecular-Weight Heparins
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...


