直接口服抗凝剂与上肢深静脉血栓瘤的标准治疗:现实世界的证据
Pedro Ruiz-Artacho1,2,3, Ramón Lecumberri4, Javier Trujillo Santos5
1Internal Medicine, Clinica Universidad de Navarra, Madrid, Spain.
Thrombosis and haemostasis
|May 19, 2025
概括
直接口服抗凝剂 (DOAC) 在治疗上肢深静脉血栓症 (UEDVT) 中表现有前途. 现实世界的数据表明,DOACs与标准疗法相比,可能会降低复发性静脉血栓栓塞和严重出血的风险.
科学领域:
- 心脏病学 心脏病学
- 血液学 血液学 血液学
- 血管医学 血管医学
背景情况:
- 在上肢深静脉血栓症 (UEDVT) 中,直接口服抗凝剂 (DOAC) 的证据有限.
- 现实世界的数据对于了解UEDVT患者的治疗疗效和安全至关重要.
研究的目的:
- 为了比较DOACs与UEDVT标准抗凝药的实际结果.
- 为了评估静脉血栓塞栓症 (VTE) 复发和在治疗后3个月内严重出血的复合结果.
主要方法:
- 从RIETE数据库 (2011年1月 - 2023年11月) 中对3,496名UEDVT患者的观察分析.
- 用DOACs治疗的患者 (n=679) 与标准治疗 (n=2,817) 的患者之间的比较.
- 多变量和多层次分析,调整以考虑混因素.
主要成果:
- 综合结局发生在接受DOAC治疗的1.0%的患者中,而接受标准治疗的2.8% (p < 0.001).
- 使用DOAC与复合结果的风险明显降低 (aSHR:0.41;95%CI:0.19-0.90).
- 在所有灵敏度分析中,结果一致,包括根据癌症状况和导管相关血栓形成的分层.
结论:
- 与标准治疗相比,直接口服抗凝剂 (DOAC) 可能与VTE复发和UEDVT患者严重出血的风险较低有关.
- 这些现实研究结果支持使用DOAC作为上肢深静脉血栓症的可行治疗选择.
- 进一步的研究可能会巩固DOAC在UEDVT管理中的作用.
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