Dabigatran was non-inferior to warfarin for prevention of recurrent venous thromboembolism (VTE), and dabigatran had a lower rate of bleeding compared with warfarin in two large-scale randomised trials, RE-COVER and RE-COVER II. In this study, we investigate the efficacy and safety of dabigatran versus warfarin according to the index event that qualified the patient for enrollment, either symptomatic pulmonary embolism (PE) with or without deep-vein thrombosis (DVT), or DVT alone. We then analyse the anticoagulant effect of dabigatran vs warfarin on patients enrolled with PE. The pooled dataset for the efficacy analysis consisted of 2553 and 2554 patients who were randomised to dabigatran and warfarin, respectively. Recurrent VTE/VTE-related death during the study period and additional 30-day follow-up occurred in 2.7 % of all patients on dabigatran and in 2.4 % on warfarin (hazard ratio [HR] 1.09 [95 % confidence interval 0.77, 1.54]). In patients with PE as their index event, recurrent VTE/VTE-related death occurred in 2.9 % vs 3.1 % of patients (HR 0.93 [0.53, 1.64]). There were significantly fewer major bleeding events in patients treated with dabigatran than with warfarin (HR 0.60 [0.36, 0.99]). The pattern was similar both in patients with PE and in those with DVT alone as the index event. These analyses of the pooled dataset from the RE-COVER and RE-COVER II trials indicate that dabigatran is as effective as warfarin in preventing recurrent VTE, regardless of whether patients present with symptomatic PE (with or without DVT) or with symptomatic DVT alone. Dabigatran was also associated with a lower risk of bleeding than warfarin, regardless of the index event.

译文

在预防复发性静脉血栓栓塞 (VTE) 方面,达比加群不逊于华法林,在两项大规模随机试验 (RE-COVER和RE-COVER II) 中,达比加群的出血率低于华法林。在这项研究中,我们根据符合患者入组条件的指数事件 (有症状的肺栓塞 (PE) 伴或不伴深静脉血栓形成 (DVT) 或单独DVT),研究达比加群与华法林的疗效和安全性。然后,我们分析达比加群与华法林对PE患者的抗凝作用。用于疗效分析的汇总数据集由2553和2554名患者组成,他们分别被随机分配到达比加群和华法林。在研究期间和额外的30天随访期间,达比加群所有患者的2.7   % 和华法林的2.4   % 发生了VTE/VTE相关的复发性死亡 (风险比 [HR] 1.09 [95  % 置信区间0.77,1.54])。以PE为指标事件的患者中,2.9   % 比3.1   % 的患者发生VTE/VTE相关的复发性死亡 (HR 0.93 [0.53,1.64])。与华法林相比,达比加群治疗的患者的主要出血事件显著减少 (HR 0.60 [0.36,0.99])。PE患者和单纯DVT患者的模式相似。这些来自RE-COVER和RE-COVER II试验的汇总数据集的分析表明,无论患者是否出现有症状的PE (有或没有DVT) 或单独有症状的DVT,达比加群在预防复发性VTE方面与华法林一样有效。无论指数事件如何,达比加群的出血风险也低于华法林。

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