在Budd-Chiari综合征中使用直接口服抗凝剂
Shrinjaya B Thapa1,2, Gabriel Roman Souza1,2, Mahati Paravathaneni1,2
1Department of Hematology/Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
European journal of haematology
|December 17, 2024
概括
在Budd-Chiari综合征 (BCS) 患者中,直接口服抗凝剂 (DOAC) 的疗效与维生素K抗剂/低分子量肝素相美. DOACs提供了管理优势,在随机试验中需要进一步调查.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 血液学 血液学 血液学
- 药理学 药理学是指药理学的学科.
背景情况:
- 布德-基亚里综合征 (BCS) 的管理包括解决肝静脉阻塞和抗凝药.
- 直接口服抗凝剂 (DOAC) 对其他静脉血栓塞栓症是有效的,但在BCS中没有充分研究.
研究的目的:
- 通过使用现有的文献,评估DOACs在初级BCS中的有效性和耐受性.
- 在BCS中,将DOAC与传统的抗凝剂,如维生素K抗体 (VKA) 和低分子量肝素 (LMWH) 进行比较.
主要方法:
- 对已发表的关于BCS患者接受DOAC治疗的研究报告的系统综述.
- 包括两个回顾性研究和九个案例报告.
- 对结果的分析,包括再缩小,治疗失败和出血事件.
主要成果:
- 回顾性研究 (58名DOAC患者,101名VKA/LMWH患者) 显示了类似的复缩/失败率 (17.2%的DOAC与15.8%的VKA/LMWH).
- 与VKA/LMWH (5.94%) 相比,DOAC的重大出血率更高 (8.62%),但DOAC的轻微出血率也更高 (20.7%vs4.95%).
- 与DOACs (4.5%) 相比,VKA/LMWH (12.8%) 的手术相关出血率较低. 病例报告表明,阿皮克萨班,里瓦罗克萨班和达比加特兰的耐受性很好.
结论:
- 在BCS中,DOAC似乎至少与VKA/LMWH在抗凝固方面同样有效.
- 由于更容易管理,DOAC可能会被优先考虑.
- 需要进行随机对照试验,以确定DOAC在BCS管理中的作用.
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