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利伐沙班每日两次用于非瓣膜性心房颤动患者左心耳血栓溶解：RIVA-TWICE研究

RIVAroxaban TWICE daily for lysis of thrombus in the left atrial appendage in patients with non-valvular atrial fibrillation: the RIVA-TWICE study.

作者信息

Piotrowski Roman, Zaborska Beata, Pilichowska-Paszkiet Ewa, Sikora-Frąc Małgorzata, Baran Jakub, Kułakowski Piotr

机构信息

Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, Warsaw, Poland.

出版信息

Arch Med Sci. 2019 Jul 12;16(2):289-296. doi: 10.5114/aoms.2019.86616. eCollection 2020.

DOI:10.5114/aoms.2019.86616
PMID:32190138
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7069443/
Abstract

INTRODUCTION

Rivaroxaban is a direct factor Xa inhibitor used once a day for prevention of thrombotic events in patients with atrial fibrillation (AF). However, in a small proportion of subjects thrombus in the left atrial appendage (LAA) is present despite this treatment. The aim of this study was assess the efficacy of increased dose of rivaroxaban (15 mg twice daily) treatment for lysis of thrombus in the LAA.

MATERIAL AND METHODS

In the RIVA-TWICE prospective, open label study, with non-blinded patients and blinded outcome assessors, rivaroxaban 15 mg twice daily for 8 weeks was administered in patients with AF who had LAA thrombus despite standard 20 mg once a day therapy. Transesophageal echocardiography was performed at baseline and after 8 weeks. Blood samples were taken to measure the activity of the anti-Xa factor.

RESULTS

Fifteen patients (9 males, mean age: 63 ±10 years) were enrolled. Following 8 weeks of rivaroxaban 15 mg twice daily, complete resolution of thrombus in the LAA was observed in 7 (46.7%) patients. The mean activity of anti-Xa factor was significantly higher during rivaroxaban twice daily therapy compared with the standard dose. However, there were no significant differences between effectively and non-effectively treated patients.

CONCLUSIONS

Rivaroxaban 15 mg twice daily seems to be safe and may dissolve LAA thrombus when standard rivaroxaban therapy is ineffective. Lower CHADS-VASc and HAS-BLED as well as preserved LAA emptying function identified responders.

摘要

引言

利伐沙班是一种直接Xa因子抑制剂，用于心房颤动（AF）患者预防血栓形成事件，每日服用一次。然而，在一小部分患者中，尽管接受了这种治疗，左心耳（LAA）仍存在血栓。本研究的目的是评估增加剂量的利伐沙班（每日两次，每次15mg）治疗LAA血栓溶解的疗效。

材料与方法

在RIVA-TWICE前瞻性、开放标签研究中，患者不设盲，结果评估者设盲，对尽管接受标准的每日一次20mg治疗但仍有LAA血栓的AF患者给予每日两次、每次15mg的利伐沙班，持续8周。在基线和8周后进行经食管超声心动图检查。采集血样以测量抗Xa因子的活性。

结果

纳入15例患者（9例男性，平均年龄：63±10岁）。在每日两次服用15mg利伐沙班8周后，7例（46.7%）患者的LAA血栓完全溶解。与标准剂量相比，每日两次服用利伐沙班期间抗Xa因子的平均活性显著更高。然而，有效治疗和无效治疗的患者之间没有显著差异。

结论

当标准利伐沙班治疗无效时，每日两次服用15mg利伐沙班似乎是安全的，且可能溶解LAA血栓。较低的CHADS-VASc和HAS-BLED评分以及保留的LAA排空功能可识别出有反应者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ec7/7069443/f24b38d1934a/AMS-16-2-37169-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ec7/7069443/fbedfde26ace/AMS-16-2-37169-g001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ec7/7069443/546167f81956/AMS-16-2-37169-g003.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ec7/7069443/f24b38d1934a/AMS-16-2-37169-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ec7/7069443/fbedfde26ace/AMS-16-2-37169-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ec7/7069443/b5bb95b50b05/AMS-16-2-37169-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ec7/7069443/546167f81956/AMS-16-2-37169-g003.jpg
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