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Lancet:房颤复律患者,依度沙班 VS. 依诺肝素–华法林(ENSURE-AF)

2016-08-30 MedSci MedSci原创

依度沙班,是一种口服Xa因子抑制剂,预防房颤患者卒中和全身性栓塞的发生并不劣于依诺肝素–华法林,且较其出血少。目前关于电复律患者使用依度沙班治疗的研究尚少。 此项多中心、前瞻性、随机、开放标签、盲终点评估试验在19个国家的239个地点进行。对比了每天60毫克依度沙班与依诺肝素–华法林在非瓣膜性房颤电复律患者中的效果。出现一个或以上因素(肌酐清除率15-50毫升/分钟,低体重[≤60公斤],或

依度沙班,是一种口服Xa因子抑制剂,预防房颤患者卒中和全身性栓塞的发生并不劣于依诺肝素–华法林,且较其出血少。目前关于电复律患者使用依度沙班治疗的研究尚少。

此项多中心、前瞻性、随机、开放标签、盲终点评估试验在19个国家的239个地点进行。对比了每天60毫克依度沙班与依诺肝素–华法林在非瓣膜性房颤电复律患者中的效果。出现一个或以上因素(肌酐清除率15-50毫升/分钟,低体重[≤60公斤],或同时使用P-糖蛋白抑制剂)后则减少依度沙班的剂量至30毫克/天。随机分层研究分析。主要疗效终点为中风、全身性栓塞事件、心肌梗塞和心血管死亡率的复合结果,采用意向治疗分析。主要安全性终点是接受至少一个剂量药物研究的患者出现主要的和临床相关的非重大(CRNM)出血。 心脏复律后对研究药物随访28天,再加30天来评估药物的安全性。

2014年3月25日至2015年10月28日期间,研究人员随机分配了2199名患者分别接受依度沙班(n = 1095)或依诺肝素–华法林(n = 1104)。平均年龄为64岁(SD 10.54)和平均CHA2DS2-VASc评分为2.6(SD 1.4)。华法林治疗范围的平均时间为70.8%(SD 27.4)。依度沙班组5名(<1%)患者达到主要疗效终点,依诺肝素–华法林组为11名(比值比[OR] 0.46,95% CI 0.12-1.43)。1067名给予依度沙班的患者中16名(1%)发生主要安全性终点, 1082名给予依诺肝素–华法林的患者中则有11名(1%)患者(OR 1.48,95% CI 0.64-3.55)。该结果独立于TEE引导策略和抗凝状态。

总而言之,ENSURE-AF是关于抗凝治疗非瓣膜性房颤患者电复律最大的前瞻性随机临床试验。两组中重大和CRNM出血以及血栓栓塞的发生率都低。

原始出处:

Andreas Goette, Jose L Merino, et al., Edoxaban versus enoxaparin–warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. The Lancet, August 30, 2016, DOI: http://dx.doi.org/10.1016/S0140-6736(16)31474-X.

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    2017-07-18 howi
  2. 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    2016-09-25 1e10c84am36(暂无匿称)

    文章很好值得关注

    0

  3. 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  4. 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createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Wed Aug 31 06:45:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107833, encodeId=a9b110e8334c, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 06:38:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107831, encodeId=f2e110e831cf, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 06:38:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-08-31 大旺旺

    学习了啊

    0

  5. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 06:38:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-08-31 段医生

    学习了。继续推广

    0

  6. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 06:38:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-08-31 1dd8a7c5m95(暂无匿称)

    学习了,赞一个!!!

    0

  7. 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createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Wed Aug 31 06:45:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107833, encodeId=a9b110e8334c, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 06:38:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107831, encodeId=f2e110e831cf, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 06:38:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-08-31 1dd8a7c5m95(暂无匿称)

    学习了,赞一个!!!

    0

  8. 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createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Wed Aug 31 06:45:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107833, encodeId=a9b110e8334c, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 06:38:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107831, encodeId=f2e110e831cf, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 06:38:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-08-31 知难而进

    值的分享!

    0

  9. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 06:38:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-08-31 1dd8a7c5m95(暂无匿称)

    学习了,赞一个!!!

    0

  10. 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createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Wed Aug 31 06:45:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107833, encodeId=a9b110e8334c, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 06:38:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107831, encodeId=f2e110e831cf, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 06:38:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-08-31 1dd8a7c5m95(暂无匿称)

    学习了,赞一个!!!

    0

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