2013心律失常及心脏起搏新进展.pptx

2013心律失常及心脏起搏新进展深圳市孙逸仙心血管医院衣为民新型口服抗凝药物在房颤卒中预防领域中的应用直接凝血酶抑制剂 Ximelagatran已退市达比加群 RE-LY1-3直接Xa因子抑制剂利伐沙班 ROCKET-AF4阿哌沙班 ARISTOTLE5依度沙班 ENGAGE AF TIMI 486RELY、ROCKET AF 和ARISTOTLE研究均已完成1. Connolly et al, 2009; 2. Wallentin et al, 2009; 3. Oldgren et al, 2010; 4. Patel et al, 2010; 5. Lopez et al, 2010 6. NCdoxaban vs. Warfarin in Patients with AFENGAGE AF-TIMI 48 Clinical TrialsMethods randomized, double-blind, double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk AFmedian follow-up, 2.8 years. The primary efficacy end point was stroke or systemic embolism. tested for noninferiority to warfarin. The principal safety end point was major bleeding.N Engl J Med. 2013 Nov 19Edoxaban vs. Warfarin in Patients with AFENGAGE AF-TIMI 48 Clinical TrialsThe annualized rate of major bleeding: 3.43% with warfarin 2.75% with high-dose edoxaban 1.61% with low-dose edoxaban.N Engl J Med. 2013 Nov 19Edoxaban vs. Warfarin in Patients with AFENGAGE AF-TIMI 48 Clinical TrialsResults The corresponding annualized rates of death from cardiovascular causes were 3.17% versus 2.74% (HR, 0.86; 95% CI, 0.77 to 0.97; P=0.01), and 2.71% (HR, 0.85; 95% CI, 0.76 to 0.96; P=0.008)The corresponding rates of the key secondary end point (a composite of stroke, systemic embolism, or death from cardiovascular causes) were 4.43% versus 3.85% (HR, 0.87; 95% CI, 0.78 to 0.96; P=0.005), and 4.23% (HR, 0.95; 95% CI, 0.86 to 1.05; P=0.32).N Engl J Med. 2013 Nov 19Edoxaban vs. Warfarin in Patients with AFENGAGE AF-TIMI 48 Clinical TrialsConclusions Both once-daily regimens of edoxaban were noninferior to warfarin with respect to the prevention of stroke or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes. N Engl J Med. 2013 Nov 19Edoxaban versus Warfarin for the Treatment of Symptomatic Venous ThromboembolismThe Hokusai-VTE study Hokusai-VTE study 结论 急性深静脉血栓和肺动脉栓塞患者