根据Oac3pad评分,旅行者的现实应用
Luís Fernandes1, Diogo Silveira1, João Peixoto1
1Angiology and Vascular Surgery Department, Vila Nova de Gaia/Espinho Hospital, Portugal.
Portuguese journal of cardiac thoracic and vascular surgery
|August 31, 2025
概括
在外周动脉疾病 (PAD) 患者,特别是慢性肢体威胁性缺血症 (CLTI) 患者中,二重途径抑制 (DPI) 可能会增加出血风险. 使用OAC3PAD评分进行仔细的风险评估对于优化抗血栓治疗至关重要.
科学领域:
- 血管外科
- 心脏病学
- 药理学
背景情况:
- 周围动脉疾病 (PAD) 携带心血管和四肢并发症的高风险.
- 抗血栓策略显著影响了复血管化后的长期结果.
- 在VOYAGER PAD试验中,Rivaroxaban和阿司匹林的益处得到了证明,但安全问题仍然存在,特别是在慢性肢体威胁性缺血 (CLTI) 患者中.
研究的目的:
- 评估在经过再血管化的PAD患者中双通道抑制 (DPI) 的适用性.
- 通过OAC3PAD评分来评估该患者队列中出血风险的分布.
- 根据VOYAGER PAD试验标准来确定适合DPI的患者比例.
主要方法:
- 在652名接受下肢再血管化治疗的患者中进行的一次回顾性研究 (2020-2023年).
- 根据OAC3PAD分数对患者进行分类,以分层出血风险.
- 根据VOYAGER PAD标准对DPI (里瓦罗克萨班加阿司匹林) 的适用性进行分析.
主要成果:
- 67. 6% 的患者 (441/ 652) 是可能接受低剂量里瓦洛克萨班治疗的候选人.
- 出血风险分布:12%高,23%中等高,46%低中等,19%低
- 在OAC3PAD风险类别 (p<0. 001) 中,DPI的适用性差异很大,在中低风险患者中最高,在高风险患者中最低.
结论:
- 现实世界PAD患者,特别是那些患有CLTI患者,可能比以前认为的更高的出血风险.
- 在近50%的CLTI患者中,由于出血风险,需要谨慎使用Rivaroxaban和阿司匹林的双通道抑制 (DPI).
- 像OAC3PAD这样的风险分层工具对于在脆弱的PAD群体中平衡抗血栓治疗的益处和风险至关重要.
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