利伐沙班和华法林在非瓣膜性心房颤动患者中的应用比较
严重瓣膜疾病患者应用利伐沙班时的出血风险高于应用华法林。该研究强调了明确非瓣膜性心房颤动定义的必要性。
ROCKET 心房颤动试验的一个亚组分析比较了利伐沙班和华法林对于非瓣膜性心房颤动患者出现卒中的预防效果。作者分析了存在严重瓣膜性疾病的患者(不包括因二尖瓣狭窄行人工主动脉瓣置换术的患者)的结局。调整混杂因素后，应用利伐沙班和华法林的严重瓣膜性疾病患者中，卒中或栓塞发生率相似。然而，利伐沙班组出现重大出血和非重大出血的风险显著增加。
严重瓣膜疾病患者应用利伐沙班时的出血风险高于应用华法林。该研究强调了明确非瓣膜性心房颤动定义的必要性。
TAKE-HOME MESSAGE
In this subgroup analysis of the ROCKET AF trial comparing rivaroxaban with warfarin for prevention of stroke with non-valvular atrial fibrillation, the authors analyzed the outcomes of patients with significant valvular disease other than mitral stenosis and aortic valve prosthesis. After adjusting for confounders, the rate of stroke or embolism with rivaroxaban vs warfarin was similar among patients with significant valvular disease. However, the rivaroxaban group had significantly increased risk for major and non-major bleeding.
Patients with significant valvular disease may have a higher risk for bleeding with rivaroxaban as compared with warfarin. This study emphasizes the need for clearly defining the meaning of non-valvular atrial fibrillation.
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