在心房动中缺血性中风后启动抗凝药的最佳延迟时间:一个务实的,响应适应的随机临床试验
Steven J Warach1, Lisa A Davis1, Patrick Lawrence1
1Dell Medical School, University of Texas at Austin.
JAMA neurology
|March 31, 2025
概括
在与心房相关的中风较早开始服用直接口服抗凝剂似乎更好,尽管在14天内没有确定单一的最佳日期. 这项研究表明,早期治疗可能会降低风险.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
背景情况:
- 临床指南建议在2周内对心房动 (AF) 进行抗凝治疗.
- 开始服用直接口服抗凝剂 (DOACs) 以平衡栓塞和出血风险的最佳时间尚不清楚.
研究的目的:
- 为了确定AF相关中风后开始DOAC治疗的最佳延迟.
- 目标是尽量减少缺血或出血事件的综合风险.
主要方法:
- 第二阶段,实用性,响应适应性随机试验 (NCT03021928) 涉及200名患者.
- 患有轻度至中度缺血性中风和AF的患者随机分配在中风后3至4天,6天,10天或14天开始DOAC.
- 主要结局是30天内的缺血性 (中风,栓塞) 或出血性 (内,全身) 事件的复合.
主要成果:
- 在3-4日组中没有发生缺血事件;分别在6日,10日和14日组中发生了3,2和2事件.
- 在3 - 4,6日和10日的每组中都发生了一次出血事件;在14日的组中没有发生过任何事件.
- 3-4天组的后后概率 (0.41) 是最佳的最高;响应适应性随机化有利于更早的启动.
结论:
- 对于DOAC启动,没有任何一天是绝对优越的.
- 有证据表明,在中风后的前2周内早期启动DOACs是AF患者二次预防的首选.
- 响应适应性随机化被证明是可行的,并有利于指导治疗时间.
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