■在外周动脉疾病(PAD)的管理中,抗凝剂或抗血小板药物的给药势在必行.双重抗血小板治疗(DAPT)与利伐沙班联合使用已显示出减轻不良结局的潜力。鉴于下肢动脉病理的异质性,个性化治疗策略有令人信服的理由.
■在一项关于外周动脉疾病药物治疗的单中心回顾性研究中,患者接受阿司匹林联合利伐沙班或阿司匹林联合氯吡格雷治疗.主要疗效结果包括卢瑟福分类的增加,急性肢体缺血,血管原因造成的截肢,靶病变血运重建,心肌梗塞,缺血性卒中,心血管死亡。主要安全性结果是大出血,根据心肌梗死溶栓(TIMI)标准的定义;同时,根据国际血栓形成和止血协会(ISTH)的分类,大出血是次要安全结局.该研究区分了两个亚组:仅膝关节上方和膝关节下方动脉病变的患者。
■从2016年1月至2021年12月,455例患者在血管内治疗(EVT)后接受了氯吡格雷加阿司匹林或利伐沙班加阿司匹林。利伐沙班组(n=220)的主要疗效结果发生率较低[49.1%vs.60.4%,风险比(HR)0.77,P=0.006],但发生更多TIMI大出血事件(5.9%vs.2.1%,HR2.6,P=0.04)。ISTH大出血事件没有显示出显著差异,尽管较高比例的利伐沙班患者因出血而停药(10%vs.4.7%,HR2.2,P=0.03)。在膝关节以上动脉疾病亚组中,利伐沙班组的主要疗效结局发生率较低(28.2%vs.45.2%,HR0.55,P=0.02)。在膝下动脉疾病亚组中,两组主要疗效事件的发生率无显著差异(58.7%vs.64.8%,HR0.76,P=0.14)。
■利伐沙班联合阿司匹林可改善下肢动脉疾病患者的预后。在仅膝关节上方动脉病变组中观察到类似的发现。然而,在仅有膝下动脉病变的组中,利伐沙班联合阿司匹林的疗效未超过DAPT.关于安全,利伐沙班联合阿司匹林比阿司匹林联合氯吡格雷具有更高的出血风险和更频繁的治疗中断.
UNASSIGNED: In the management of Peripheral Arterial Disease (PAD), the administration of anticoagulant or antiplatelet agents is imperative. The use of Dual Antiplatelet Therapy (DAPT) in conjunction with rivaroxaban has shown potential in mitigating adverse outcomes. Given the heterogeneity in the pathology of lower limb arteries, there is a compelling case for individualized treatment strategies.
UNASSIGNED: In a single-center retrospective study on pharmacotherapy for peripheral artery disease, patients were treated with either aspirin combined with rivaroxaban or aspirin coupled with clopidogrel. The primary efficacy outcome encompassed a composite of increases in the Rutherford classification, acute limb ischemia, amputations due to vascular causes, target lesion revascularization, myocardial infarction, ischemic stroke, and cardiovascular death. The primary safety outcome was major bleeding, as defined by the Thrombolysis in Myocardial Infarction (TIMI) criteria; meanwhile, major bleeding as categorized by the International Society on Thrombosis and Haemostasis (ISTH) served as a secondary safety outcome. The study differentiated between two subgroups: patients with only above-the-knee and below-the-knee arterial lesions.
UNASSIGNED: From January 2016 to December 2021, 455 patients received either clopidogrel plus aspirin or rivaroxaban plus aspirin following endovascular treatment (EVT). The rivaroxaban group (n = 220) exhibited a lower incidence of primary efficacy outcomes [49.1% vs. 60.4%, hazard ratio (HR) 0.77, P = 0.006] but had more TIMI major bleeding events (5.9% vs. 2.1%, HR 2.6, P = 0.04). ISTH major bleeding events did not show a significant difference, though a higher percentage of rivaroxaban patients discontinued medication due to bleeding (10% vs. 4.7%, HR 2.2, P = 0.03). In the above-the-knee arterial disease subgroup, the rivaroxaban group demonstrated a lower incidence of primary efficacy outcomes (28.2% vs. 45.2%, HR 0.55, P = 0.02). In the below-the-knee arterial disease subgroup, no significant difference was observed in the occurrence of primary efficacy events between the two groups (58.7% vs. 64.8%, HR 0.76, P = 0.14).
UNASSIGNED: Rivaroxaban plus aspirin improved outcomes compared to DAPT in patients with lower extremity artery disease. Similar findings were observed in the above-the-knee artery lesion-only group. However, in the below-the-knee artery lesion-only group, rivaroxaban plus aspirin did not surpass DAPT in efficacy. Regarding safety, rivaroxaban plus aspirin exhibited higher bleeding risks and more frequent treatment discontinuation than aspirin combined with clopidogrel.