Management and clinical outcomes in patients treated with apixaban vs warfarin undergoing procedures
Management and clinical outcomes in patients treated with apixaban vs warfarin undergoing procedures
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DOI：
10.1182/blood-2014-08-595496
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发表时间：
2014-12-11
期刊：
影响因子：
20.3
通讯作者：
Lopes, Renato D.
中科院分区：
文献类型：
--
作者：
Garcia, David;Alexander, John H.;Lopes, Renato D.
使用来自ARISTOTLE的数据，我们描述了长期使用华法林或阿哌沙班抗凝的患者的围手术期抗凝管理和后续临床结局的发生率。我们记录了术前是否中断抗凝治疗（以及中断时间），是否使用桥接治疗，以及术后30天内发生重要临床结局的患者比例。在5924例患者的随访期间进行的10674例手术中，9260例被纳入本分析。术前抗凝治疗37.5%未中断。术后30天内，阿哌沙班治疗患者中16/4624（0.35%）例手术后发生卒中或全身性栓塞，华法林治疗患者中26/4530（0.57%）例手术后发生卒中或全身性栓塞（比值比[OR] 0.601; 95%置信区间[CI] 0.322-1.120）。阿哌沙班组74/4560（1.62%）例手术和华法林组86/4454（1.93%）例手术发生大出血（OR 0.846; 95% CI 0.614-1.166）。阿哌沙班（54/4624 [1.17%]）和华法林（49/4530 [1.08%]）的死亡风险相似（OR 1.082; 95% CI 0.733-1.598）。在ARISTOTLE患者中，无论是否提前停止抗凝治疗，阿哌沙班和华法林治疗患者的术后30天卒中、死亡和大出血发生率均较低且相似。我们的研究结果表明，许多长期抗凝的患者可以安全地接受手术;有些患者不需要术前中断抗凝。亚里士多德在www.clinicaltrials.gov上注册为#NCT00412984。
Using data from ARISTOTLE, we describe the periprocedural management of anticoagulation and rates of subsequent clinical outcomes among patients chronically anticoagulated with warfarin or apixaban. We recorded whether (and for how long) anticoagulant therapy was interrupted preprocedure, whether bridging therapy was used, and the proportion of patients who experienced important clinical outcomes during the 30 days postprocedure. Of 10 674 procedures performed during follow-up in 5924 patients, 9260 were included in this analysis. Anticoagulant treatment was not interrupted preprocedure 37.5% of the time. During the 30 days postprocedure, stroke or systemic embolism occurred after 16/4624 (0.35%) procedures among apixaban-treated patients and 26/4530 (0.57%) procedures among warfarin-treated patients (odds ratio [OR] 0.601; 95% confidence interval [CI] 0.322-1.120). Major bleeding occurred in 74/4560 (1.62%) procedures in the apixaban arm and 86/4454 (1.93%) in the warfarin arm(OR0.846; 95% CI 0.614-1.166). The risk of death was similar with apixaban (54/4624 [1.17%]) and warfarin (49/4530 [1.08%]) (OR 1.082; 95% CI 0.733-1.598). Among patients in ARISTOTLE, the 30-day postprocedure stroke, death, and major bleeding rates were low and similar in apixaban- and warfarin-treated patients, regardless of whether anticoagulation was stopped beforehand. Our findings suggest that many patients on chronic anticoagulation can safely undergo procedures; some will not require a preprocedure interruption of anticoagulation. ARISTOTLE was registered at www.clinicaltrials.gov as #NCT00412984.