Haematology Department, Monash Medical Centre, Monash Health, Clayton Road, Clayton, VIC, 3168, Australia.
Diagnostic Imaging, Monash Health, Melbourne, VIC, Australia.
J Thromb Thrombolysis. 2020 Feb;49(2):220-227. doi: 10.1007/s11239-019-01944-4.
Residual perfusion defects (RPD) as detected by lung scintigraphy occur in over 50% of patients with acute pulmonary embolism (PE) treated with vitamin K antagonists but there is lack of data in patients treated with direct oral anticoagulants. The aim of this retrospective study was to estimate the incidence of RPD detected by ventilation perfusion (VQ) scan at 3-6 months in patients with first acute symptomatic PE treated with rivaroxaban compared to warfarin. Consecutive eligible patients treated with rivaroxaban as part of a previous study were identified. The Monash Health Radiology database was used to identify a historical cohort of age matched (± 5 years) patients treated with warfarin. Follow-up VQ scans were classified as normal (no perfusion defect) or abnormal (matched or unmatched perfusion defects) by two independent nuclear medicine physicians blinded to treatment. Any disagreement was resolved by consensus. One hundred and ninety patients with PE (95 in each cohort) were included (mean age 56.8 years; 41.1% males; 54.2% unprovoked). In the overall cohort, 31.1% had RPD with a significantly lower incidence of RPD in rivaroxaban treated patients 23.2% (95% CI 15.8-32.6), compared to warfarin 38.9% (95% CI 29.8-49.0). Treatment with rivaroxaban was associated with a significantly lower incidence of RPD detected by VQ scan at 3-6 months compared to warfarin. This supports recent in-vitro data suggesting an indirect enhancement of fibrinolysis by direct oral Xa inhibitors but requires confirmation in larger studies.
肺闪烁显像检测到的残余灌注缺损（RPD）在接受维生素 K 拮抗剂治疗的急性肺栓塞（PE）患者中超过 50%，但在接受直接口服抗凝剂治疗的患者中缺乏数据。本回顾性研究的目的是评估与华法林相比，接受利伐沙班治疗的首次急性有症状 PE 患者在 3-6 个月时通气灌注（VQ）扫描检测到 RPD 的发生率。确定了之前研究中接受利伐沙班治疗的符合条件的连续患者。使用 Monash Health 放射学数据库来确定年龄匹配（±5 岁）的接受华法林治疗的历史队列患者。由两名独立的核医学医师进行盲法评估，根据 VQ 扫描将随访结果分为正常（无灌注缺损）或异常（匹配或不匹配的灌注缺损）。任何分歧均通过共识解决。共纳入 190 例 PE 患者（每组 95 例；平均年龄 56.8 岁；41.1%为男性；54.2%为无诱因）。在总体队列中，31.1%的患者有 RPD，利伐沙班组 RPD 的发生率明显较低（95%CI 15.8-32.6），而华法林组为 38.9%（95%CI 29.8-49.0）。与华法林相比，利伐沙班治疗与 3-6 个月时 VQ 扫描检测到的 RPD 发生率明显降低相关。这支持最近的体外数据表明直接口服 Xa 抑制剂间接增强纤溶，但需要在更大的研究中证实。
