Kabuki Takayuki, Nakanishi Rine, Hisatake Shinji, Fujii Takahiro, Dobashi Shintaro, Wakakura Shingo, Kiuchi Shunsuke, Fujino Tadashi, Ikeda Takanori
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
J Cardiol. 2017 Aug;70(2):163-168. doi: 10.1016/j.jjcc.2016.10.013. Epub 2016 Dec 12.
The factor Xa inhibitors have been widely used for the treatment and prevention of venous thromboembolism (VTE). However, the efficacy of factor Xa inhibitors in Japanese patients with VTE has not been well examined. In this study, we investigated the effect of the sequential use of two factor Xa inhibitors in patients with acute VTE.
We conducted an observational study of 87 consecutive patients diagnosed with VTE. As an initial treatment, we administered subcutaneous fondaparinux to the patients for 7-10 days, and then switched to oral rivaroxaban. The symptoms and findings were assessed after the initial treatment and after using rivaroxaban for 7-14 days. We evaluated the deep vein thrombosis (DVT) in the legs using our own scoring system [quantitative ultrasound thrombosis (QUT) score].
Of the 87 patients, 33% had symptoms, half had pulmonary embolism (PE), and 95% had DVT of the legs. Out of the 87 patients, VTE worsened during the administration of fondaparinux in 4 patients. All of them had experienced malignancy, and died within 6 months. Of two patients developing bleeding, one patient required a transfusion. Eventually, this strategy was effective in 80 patients and had no change in one. The D-dimer level was significantly reduced by fondaparinux (17.8μg/ml±16.0μg/ml vs. 8.3μg/ml±7.2μg/ml, p<0.0001), followed by rivaroxaban (8.3μg/ml±7.2μg/ml vs. 5.5μg/ml±4.9μg/ml, p<0.0001). Similarly, the QUT score was improved by fondaparinux (4.7±2.6 vs. 2.5±2.5, p<0.0001), and further reduced by rivaroxaban (2.5±2.5 vs. 1.9±1.8, p<0.0001).
A treatment strategy using subcutaneous fondaparinux followed by oral rivaroxaban is effective for treating acute VTE in Japanese patients.
Xa因子抑制剂已广泛用于静脉血栓栓塞症（VTE）的治疗和预防。然而，Xa因子抑制剂在日本VTE患者中的疗效尚未得到充分研究。在本研究中，我们调查了序贯使用两种Xa因子抑制剂对急性VTE患者的影响。
我们对87例连续诊断为VTE的患者进行了一项观察性研究。作为初始治疗，我们给患者皮下注射磺达肝癸钠7 - 10天，然后换用口服利伐沙班。在初始治疗后以及使用利伐沙班7 - 14天后评估症状和检查结果。我们使用自己的评分系统[定量超声血栓形成（QUT）评分]评估腿部深静脉血栓形成（DVT）。
87例患者中，33%有症状，半数有肺栓塞（PE），95%有腿部DVT。87例患者中，4例在使用磺达肝癸钠期间VTE恶化。他们均患有恶性肿瘤，并在6个月内死亡。在2例发生出血并发症的患者中，1例需要输血。最终，该策略对80例患者有效，1例无变化。磺达肝癸钠使D-二聚体水平显著降低（17.8μg/ml±16.0μg/ml对8.3μg/ml±7.2μg/ml，p<0.0001），随后利伐沙班使其进一步降低（8.3μg/ml±7.2μg/ml对5.5μg/ml±4.9μg/ml，p<0.0001）。同样，磺达肝癸钠改善了QUT评分（4.7±2.6对2.5±2.5，p<0.0001），利伐沙班使其进一步降低（2.5±2.5对1.9±1.8，p<0.0001）。
皮下注射磺达肝癸钠后口服利伐沙班的治疗策略对治疗日本急性VTE患者有效。
