心声图血动力学与非膜性心房的DOAC特异性出血和中风率的差异相关
Michael P O'Shea1,2,3, Ali Yusuf4, Eiad Habib4
1Mayo Clinic, 134000 E Shea Blvd, Scottsdale, AZ, 85259, USA. osheam12@tcd.ie.
直接口服抗凝剂 (DOAC) 降低了非膜性心房动中风的风险. 右心室缩压升高 (RVSP) 增加了大比加特兰和里瓦罗克萨班的出血风险,但不是阿皮克萨班.
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.
- 医疗成像医学成像
背景情况:
- 直接口服抗凝剂 (DOAC) 是预防非膜动/动 (NVAF) 中中风的标准.
- 不同的DOAC表现出不同的出血形状,apixaban被认为是风险最低的.
- 右心室缩压 (RVSP) 是一种心声回声测量仪,可以影响出血风险.
研究的目的:
- 为了研究DOAC选择和RVSP在心声回声图上的相互作用,关于出血率.
- 测试假设高RVSP与增加出血有关,可能由DOAC药理性质调节.
主要方法:
- 一个临床数据库的回顾性分析,涉及了接受心声回声扫描的患者.
- 采用多变量回归模型来评估出血率,并对混因素进行调整.
- 对DOAC选择和RVSP状态的交互条款被纳入模型.
主要成果:
- 与里瓦罗克萨班和达比加特兰相比,阿皮克萨班与较低的出血率有关.
- 在没有高RVSP的患者中,在DOAC之间没有观察到出血率的显著差异.
- 在RVSP≥45mmHg的患者中,与阿皮克萨班相比,达比加特兰和里瓦罗克萨班显著增加出血率 (分别增加90%和86%).
结论:
- 升高的RVSP是某些DOAC患者过度出血的重要危险因素.
- 与升高的RVSP相关的出血风险增加与达比加特兰和里瓦罗克萨班观察到,但不是阿皮克萨班.
- 这些发现强调了考虑RVSP与DOAC选择结合在NVAF患者中进行个性化出血风险评估的重要性.
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