低剂量里瓦洛克萨班加上阿司匹林在患有PAD的患者中进行下肢再血管化,有或没有先前肢体再血管化史:来自VOYAGER-PAD试验的见解
Mario Enrico Canonico1,2, Jessica Parr3, E Sebastian Debus4
1CPC Clinical Research, Aurora, CO (M.E.C., M.R.N., C.N.H., W.H.C., J.Y., J.C., M. Szarek, S.D.B., M.P.B.).
Circulation. Cardiovascular interventions
|February 27, 2026
概括
患有外周动脉疾病 (PAD) 的患者接受下肢再血管化 (LER),并且有LER病史,面临更高的风险. 里瓦洛克萨班显著减少主要不良四肢事件 (MALE) 和心血管事件,为以前有LER的人提供更大的好处.
科学领域:
- 心血管医学 心血管医学
- 血管外科 血管外科
- 药理学 药理学是指药理学的学科.
背景情况:
- 经过下肢再血管化 (LER) 的外周动脉疾病 (PAD) 患者面临重大不良四肢事件 (MALE) 和心血管事件的高风险.
- VOYAGER-PAD试验显示,里瓦罗克萨班加抗血小板治疗可以降低这些风险.
- 里瓦罗克萨班在患有LER病史的患者的影响的一致性以前未被描述.
研究的目的:
- 为了评估MALE和PAD患者的重大不良心血管事件的风险,无论有或没有以前的LER.
- 为了确定rivaroxaban的疗效和安全性概况是否基于之前的LER史而有所不同.
主要方法:
- 在VOYAGER-PAD试验中,随机选择了患有症状的PAD患者,接受了LER的里瓦洛克萨班或安慰剂,用阿司匹林作为背景治疗.
- 在基线时收集了患者先前的LER病史.
- 主要终点:急性四肢缺血,血管截肢,心肌梗塞,中风或心血管死亡的组合. 安全终点:心肌梗塞中的血栓溶解 大型出血.
主要成果:
- 在6564名患者中,有35.5%的患者先前有LER病史,MALE发病率较高 (12.9%与8.0%相比).
- 里瓦罗克萨班降低了初级终点,在以前LER (HR 0.73) 与没有LER (HR 0.94;Pinteraction=0.036) 的患者中,相对益处在数值上更大.
- 里瓦洛克萨班的重大出血风险增加在各组一致 (Pinteraction=0.16).
结论:
- 之前有LER的PAD患者患有MALE的风险明显更高.
- 里瓦罗克萨班在减少MALE和心血管事件方面表现出更大的相对益处,对于之前有LER病史的PAD患者.
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