Successful COMPASS, Disappointing COMMANDER HF, What Have We Learned From These Two Trials?
Successful COMPASS, Disappointing COMMANDER HF, What Have We Learned From These Two Trials?
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成功的COMPASS，令人失望的COMMANDER HF，我们从这两次试验中学到了什么？
DOI：
10.1097/fjc.0000000000000712
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发表时间：
2019-10-01
影响因子：
3
通讯作者：
Zhou, Shenghua
中科院分区：
文献类型：
--
作者：
He, Yuhu;Hu, Xinqun;Zhou, Shenghua
尽管心力衰竭领域的药物和器械治疗取得了相当大的进展，但心力衰竭患者的死亡率仍然很高。研究表明，血栓栓塞和中风与心力衰竭患者的高死亡率相关。尽管华法林治疗降低了心力衰竭患者缺血性卒中的发生率，但华法林在该人群中的总体获益似乎被出血风险增加所抵消。因此，对于慢性心力衰竭患者，尤其是窦性心律患者，是否可以从抗凝治疗中获益仍存在争议。新型口服抗凝剂利伐沙班是一种选择性的Xa因子直接抑制剂，用于减少凝血酶的生成，这可能为心力衰竭患者的抗凝治疗带来希望。然而，COMPASS试验和最近发表的COMMANDER HF试验显示了不同的结果。通过仔细分析2项临床试验，我们认为有几个因素可以解释这种不同的结果。
Despite considerable progress in the field of heart failure about drugs and device therapy, the mortality rate of patients with heart failure remains high. Studies have shown that thromboembolism and stroke are associated with high mortality in patients with heart failure. Although warfarin therapy reduces the rate of ischemic stroke in patients with heart failure, the overall benefit from warfarin in this population seems to be offset by the increased bleeding risk. Thus, whether patients with chronic heart failure might benefit from anticoagulation, especially in patients with sinus rhythm, is still controversial. Rivaroxaban, a new oral anticoagulant, is a selective direct factor Xa inhibitor that is used to reduce thrombin generation, which may bring hope to anticoagulation in patients with heart failure. However, the COMPASS trial and recently published COMMANDER HF trial presented different results. By carefully analyzing 2 clinical trials, we think several factors might explain this different outcome.