使用阿皮克萨班与阿司匹林严重出血:ARTESiA随机临床试验的次分析
Deborah M Siegal1,2, Christian Sticherling3, Jeff S Healey4,5
1Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
JAMA cardiology
|November 12, 2025
概括
阿皮克萨班在亚临床心房动 (SCAF) 患者中减少了中风,但增加了主要出血,特别是胃肠道出血. 出血的危险因素包括NSAID使用,癌症,阿皮克萨班治疗和年龄较大.
科学领域:
- 心脏病学 心脏病学
- 临床试验 临床试验
- 药理学 药理学是指药理学的学科.
背景情况:
- 亚临床心房动 (SCAF) 与中风风险增加有关.
- 抗凝剂治疗对于SCAF患者中风预防至关重要.
- ARTESiA试验研究了阿皮克萨班与阿司匹林用于SCAF管理.
研究的目的:
- 在SCAF患者治疗阿皮克萨班与阿司匹林的重大出血事件的特征.
- 为了确定与该人群中大出血相关的因素.
主要方法:
- 预先指定ARTESiA随机临床试验的子分析.
- 国际,双盲,双模拟设计.
- 包括患有SCAF和中风风险因素的患者,随机分配给阿皮克萨班或阿司匹林.
主要成果:
- 与阿司匹林相比,阿皮克萨班增加了严重出血的发生率 (每100个患者年1.71比0.94).
- 大型胃肠道出血在阿皮克萨班患者中较高,而内和致命出血的发生率相似.
- 出血事件往往是非突发性的,其特点是血红蛋白降低≥2g/dL.
- 使用NSAID,癌症,阿皮克萨班治疗和年龄增长与更高的出血风险有关.
结论:
- 在SCAF患者中使用阿皮克萨班与严重出血风险增加有关,主要是胃肠道出血.
- 尽管增加了出血风险,但与阿司匹林相比,阿皮克萨班并没有增加内或致命出血率.
- 在SCAF患者中,对出血的风险分层是必不可少的,考虑到NSAID使用,癌症和年龄等因素.
相关概念视频
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
1.0K
Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
1.0K
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
2.0K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
2.0K
Anticoagulant Drugs: Low-Molecular-Weight Heparins
1.6K
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
1.6K
Venous Thrombosis III: Interprofessional Care
254
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
254


