房颤卒中预防现状和未来课件.ppt

ROCKET AF研究中入组的人群既具有卒中的高风险，也具有出血的高风险。 * G02-536 w_script.ppt * * 从上图可以看到，阿哌沙班的疗效优于剂量调整的华法林，使卒中或全身性栓塞事件的发生风险下降21％。 在大出血事件发生率方面，阿哌沙班组也优于华法林组。 从ARISTOTLE的疗效和安全性结果上来看，似乎是一个双赢的结果：既降低卒中风险，又降低卒中风险。但是大家需要注意的是，在ARISTOTLE研究中，对于出血的定义和在RELY，ROCKET AF中是不一样的。 在ARISTOTLE中，对于大出血定义中”血红蛋白下降≥2g/dl“限定在最后一次给药后24小时期间的血红蛋白下降≥2g/dl才被计算在内；而在ROCKET AF和RELY研究中，对”血红蛋白下降≥2g/dl“均是在最后一次给药后48小时内进行评估的。因此，在ARISTOTLE研究中，大出血的发生率是被低估的了。 * Background—Rivaroxaban and dabigatran are new oral anticoagulants that specifically inhibit factor Xa and thrombin, respectively. Clinical studies on the prevention and treatment of venous and arterial thromboembolism show promising results. A major disadvantage of these anticoagulants is the absence of an antidote in case of serious bleeding or when an emergency intervention needs immediate correction of coagulation. This study evaluated the potential of prothrombin complex concentrate (PCC) to reverse the anticoagulant effect of these drugs. Methods and Results—In a randomized, double-blind, placebo-controlled study, 12 healthy male volunteers received rivaroxaban 20 mg twice daily (n6) or dabigatran 150 mg twice daily (n6) for 21?2 days, followed by either a single bolus of 50 IU/kg PCC (Cofact) or a similar volume of saline. After a washout period, this procedure was repeated with the other anticoagulant treatment. Rivaroxaban induced a significant prolongation of the prothrombin time (15.81.3 versus 12.30.7 seconds at baseline; P0.001) that was immediately and completely reversed by PCC (12.81.0; P0.001). The endogenous thrombin potential was inhibited by rivaroxaban (5122%; baseline, 9222%; P0.002) and normalized with PCC (11426%; P0.001), whereas saline had no effect. Dabigatran increased the activated partial thromboplastin time, ecarin clotting time (ECT), and thrombin time. Administration of PCC did not restore these coagulation tests. Conclusion—Prothrombin complex concentrate immediately and completely reverses the anticoagulant effect of rivaroxaba