Administration of Direct Oral Anticoagulant Immediately after Unfractionated Heparin Bolus for the Treatment of Intermediate-High-Risk Pulmonary Thromboembolism.
Administration of Direct Oral Anticoagulant Immediately after Unfractionated Heparin Bolus for the Treatment of Intermediate-High-Risk Pulmonary Thromboembolism.
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DOI：
10.3400/avd.oa.20-00079
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发表时间：
2020-12-25
影响因子：
0.8
通讯作者：
Ashikaga T
中科院分区：
文献类型：
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作者：
Hara N;Watanabe K;Miyazaki R;Nakamura T;Lee T;Nagata Y;Nozato T;Miyamoto T;Obayashi T;Ashikaga T
目的：本研究旨在评价普通肝素（UFH）推注后直接口服抗凝剂（DOAC）治疗中高危肺栓塞的疗效和安全性。材料与方法：在初始治疗的基础上，将81例患者分为两组：UFH推注后DOAC组（D组; n=32）和常规治疗组（C组; n=49）。比较6个月内静脉血栓栓塞（VTE）复发和出血的频率。此外，还评估了慢性期的住院时间和计算机断层扫描（CT）显示的肺动脉血栓减少率。结果如下：D组和C组分别有1例（3.1%）和3例（6.1%）患者（P=1.00）发生VTE复发，而D组和C组分别有8.2%的患者（P=0.15）未发生出血事件。D组住院时间（7.2±2.3）d较C组（15.7±9.9）d短（P<0.001）。在连续CT评估的患者亚组（D组，n=20; C组，n=38）中，肺动脉血栓几乎全部消失，两组之间的血栓减少率相似（D组，99.5%; C组，97.1%; P=0.59）。结论：UFH推注治疗后立即给予DOAC具有相同的疗效和安全性，而住院天数明显短于常规治疗组。
Objective: This study aims to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) after unfractionated heparin (UFH) bolus for the treatment of intermediate–high-risk pulmonary embolism. Materials and Methods: On the basis of initial treatment, 81 patients were divided into two groups: DOAC after UFH bolus infusion group (group D; n=32) and conventional therapy group (group C; n=49). The frequency of recurrence of venous thromboembolism (VTE) and bleeding within 6 months were compared. In addition, hospitalization length and thrombus reduction rate in the pulmonary artery on computed tomography (CT) at the chronic phase were assessed. Results: Recurrence of VTE was found in one (3.1%) and three patients (6.1%) (P=1.00) in groups D and C, respectively, whereas no bleeding events was found in group D and 8.2% of patients in group C (P=0.15). Group D showed shorter hospitalization (7.2±2.3 days) than group C (15.7±9.9 days; P<0.001). In the subset of patients with serial CT assessment (group D, n=20; group C, n=38), almost all thrombus of pulmonary artery were disappeared and the thrombus reduction rates were similar between the two groups (group D, 99.5%; group C, 97.1%; P=0.59). Conclusion: DOAC administration immediately after UFH bolus treatment has the same efficacy and safety, whereas hospitalization days were significantly shorter than the conventional treatment group.