在急性静脉血栓栓塞症中,阿皮克萨班与里瓦罗克萨班的出血风险
Lana A Castellucci1, Vivien M Chen2,3,4, Michael J Kovacs5
1Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa.
The New England journal of medicine
|March 11, 2026
概括
与里瓦洛克萨班相比,阿皮克萨班在急性静脉血栓塞栓症患者中显著降低了出血风险. 这项为期3个月的试验发现阿皮克萨班是一种更安全的口服抗凝剂选择,降低了临床相关的出血事件.
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.
- 临床试验 临床试验
背景情况:
- 阿皮克萨班和里瓦罗克萨班是治疗急性静脉血栓栓塞 (VTE) 的领先的口服抗凝剂.
- 在静脉瘤患者中比较阿皮克萨班和里瓦罗克萨班之间的出血风险的临床数据仍然有限.
- 了解不同出血形状对于优化静脉瘤治疗策略至关重要.
研究的目的:
- 直接比较患有急性静脉动脉瘤的患者中阿皮克萨班和里瓦罗克萨班之间临床相关出血的发生率.
- 评估二次结果,包括所有原因的死亡率,在接受抗凝剂治疗的患者中.
主要方法:
- 一个国际,前性,随机化,开放标签,盲目的终点试验,涉及2760名急性肺栓塞或深静脉血栓塞的患者.
- 患者接受阿皮克萨班 (10毫克每天两次7天,然后每天两次5毫克) 或里瓦罗克萨班 (15毫克每天两次21天,然后每天20毫克) 3个月.
- 主要终点是主要或临床相关的非主要出血的组合,使用国际血栓学会和血液静止学会的标准进行评估.
主要成果:
- 主要结局事件发生在3.3%的阿皮克萨班组和7.1%的里瓦罗克萨班组 (相对风险:0.46;95% CI,0.33-0.65;P<0.001).
- 在两组中,全因死亡率都很低 (阿皮克萨班为0.1%,里瓦罗克萨班为0.3%).
- 与出血或血栓形成无关的严重不良事件在两组之间是可比的.
结论:
- 与里瓦洛克萨班相比,阿皮克萨班在治疗急性静脉血栓栓塞症的患者中显示出临床相关出血的风险明显较低,持续3个月.
- 这些发现表明,阿皮克萨班可能在这个患者群体中提供更高的安全性概况,以预防出血并发症.
- 进一步的研究可能会探索长期结果和特定的患者子组.
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