低剂量里瓦洛克萨班预防前心肌梗塞后左心室血栓形成:APERITIF随机临床试验
Etienne Puymirat1,2,3, Gilles Soulat4,5, Benoit Lattuca3,6
1Department of Cardiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
JAMA cardiology
|February 25, 2026
概括
在双抗血小板治疗 (DAPT) 中添加低剂量里瓦罗克萨班,并没有显著减少前侧ST升高心肌梗塞 (STEMI) 患者的左心室 (LV) 血栓. 然而,它确实增加了轻微的出血事件,由于研究的局限性,需要谨慎解释.
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:
- 前急性心肌梗塞 (MI) 增加了左心室 (LV) 血栓形成的风险.
- 将口服抗凝剂添加到双抗血小板疗法 (DAPT) 的疗效和安全性,用于预防前期STEMI后的LV血栓,尚未得到充分证实.
研究的目的:
- 为了评估低剂量里瓦罗克萨班添加到DAPT是否减少1个月后LV血栓发生率在前部ST段升高心肌梗塞 (STEMI) 患者.
- 评估这种联合治疗的安全性,包括主要和轻微的出血事件.
主要方法:
- 一个多中心,开放标签,盲目的终点随机临床试验,涉及560名前部STEMI患者.
- 参与者接受了DAPT加Rivaroxaban (2.5毫克每天两次,持续4周) 或单独接受DAPT.
- 主要终点是1个月后通过对比增强的心脏磁共振成像检测LV血栓.
主要成果:
- 在接受里瓦洛克萨班加DAPT的患者中,LV血栓检测到13.7%,仅接受DAPT的患者为16.6% (P=.34).
- 两组之间没有观察到LV血栓大小或主要心血管不良事件的显著差异.
- 主要出血事件是可比的,但轻微出血 (BARC型1) 在里瓦洛克萨班组中发生的频率更高 (16.4%vs7.2%).
结论:
- 在1个月后,将低剂量里瓦罗克萨班添加到DAPT中并没有显著减少前部STEMI患者的LV血栓形成.
- 组合疗法导致较高的轻微出血事件发生率.
- 由于研究的力量有限,研究结果应谨慎解释;不能排除温和的影响.
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