阿斯匹林療效類抗凝血藥

阿斯匹林療效類抗凝血藥
國際研究指出,對多數有心臟衰竭問題的病患來說,阿斯匹林(Aspirin)的功效與抗凝血藥 Warfarin(或可邁丁,Coumadin)相似,特別在預防死亡、中風或腦出血方面。

這份刊登於「新英格蘭醫學期刊」(New England Journal of Medicine)的研究,歷經 10 年重要臨床實驗,以及追蹤11 國 2,305 名病患才完成。

The investigators designed this trial to determine whether warfarin (with a target international normalized ratio of 2.0 to 3.5) or aspirin (at a dose of 325 mg per day) is a better treatment for patients in sinus rhythm who have a reduced left ventricular ejection fraction (LVEF). They followed 2305 patients for up to 6 years (mean [±SD], 3.5±1.8). The primary outcome was the time to the first event in a composite end point of ischemic stroke, intracerebral hemorrhage, or death from any cause.

服用 Warfarin 患者每年死亡、中風和腦內出血的綜合風險為 7.47%,而服阿斯匹林的患者則為 7.93%,研究人員表示,這兩個數據在統計學意義上差距並不明顯。

Among patients with reduced LVEF who were in sinus rhythm, there was no significant overall difference in the primary outcome between treatment with warfarin and treatment with aspirin. A reduced risk of ischemic stroke with warfarin was offset by an increased risk of major hemorrhage. The choice between warfarin and aspirin should be individualized.

研究人員說,服用抗凝血藥 Warfarin 的病人中風機率是服阿斯匹林患者的一半,但重大出血的機率卻多了一倍,所以這2 項要素互相抵消。

研究指出,有些證據顯示,研究人員追蹤服用 Warfarin 的患者 4 年或以上後發現,Warfarin 在預防死亡、中風或腦出血的表現較優,但仍須更多分析佐證。

哥倫比亞大學醫學中心(Columbia University Medical Center)的本間俊⼀(Shunichi Homma)說:「因為阿斯匹林與Warfarin 的整體風險與療效相似,病人的醫師可依照最符合病人的個別醫療需要,自由選擇治療藥物。」「不過,有鑑於阿斯匹林獲取方便且價格低廉,許多人應該會選用阿斯匹林治療。」

【資料來源:中國醫藥大學附設醫院 衛教健康分享網

 


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