Quality of life after switching from well-controlled vitamin K antagonist to direct oral anticoagulant: Little to GAInN
Quality of life after switching from well-controlled vitamin K antagonist to direct oral anticoagulant: Little to GAInN
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DOI：
10.1016/j.thromres.2020.04.007
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发表时间：
2020-06-01
影响因子：
7.5
通讯作者：
Meijer, Karina
中科院分区：
文献类型：
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作者：
Miert, Jasper H. A. van;Kooistra, Hilde A. M.;Meijer, Karina
背景：直接口服抗凝剂（DOAC）和维生素K拮抗剂（VKA）可预防房颤（AF）患者的血栓栓塞。DOAC有固定的给药方案和CINR监测。因此，DOAC对生活质量（QoL）的影响可能小于VKA。然而，一些VKA用户欣赏监控。治疗范围内的时间（TTR）长，对QoL的影响较低。我们评估了从控制良好的VKA切换到DOAC对QoL.Methods的影响：在GAInN研究中，241例AF患者，TTR >= 70%，VKA时既没有出血也没有血栓形成，随机切换到DOAC（n= 121）或继续VKA（n= 120）。健康相关的（SF-36）和抗凝相关的生活质量（PACT-Q）进行了评估，在基线和6个月和12个月后follows.Results和结论。SF-36的发展没有组间差异。一年后，DOAC的平均PACT-Q便利性改善高出2.5（0.3-4.7）。DOAC使用者在便利性上提高> 5分的可能性高6%（95%CI -4-16）; 22 pp. (95%CI 1-43）。有意义地提高PACT-Q满意度的可能性为12 pp。(95%CI 0-25）。然而，5名（4.1%）和4名（3.3%）DOAC使用者因副作用和患者偏好而恢复VKA。从控制良好的VKA转换为DOAC治疗AF可提高PACT-Q便利性和满意度的可能性，但也会增加副作用的风险。可以说，只有对VKA不满意的患者才应该更换，因为他们通过更换可以获得更多好处。
Background: Direct oral anticoagulants (DOAC) and vitamin K antagonists (VKA) prevent thromboembolism in atrial fibrillation (AF). DOAC have a fixed dosing regimen and obviate INR monitoring. Therefore, DOAC presumably affect quality of life (QoL) less than VKA. However, some VKA users appreciate the monitoring. A high time in the therapeutic range (TTR) leads to a lower impact on QoL. We assessed the influence of switching from well-controlled VKA to a DOAC on QoL.Methods: In the GAInN study, 241 patients with AF, a TTR >= 70%, and neither bleeding nor thrombosis while on VKA were randomised to switching to DOAC (n= 121) or continuing VKA (n= 120). Health-related (SF-36) and anticoagulation-related QoL (PACT-Q) was assessed at baseline and after six and twelve months of follow-up.Results and Conclusion.SF-36 development did not differ between groups. After one year, average PACT-Q Convenience improvement was 2.5 (0.3-4.7) higher on DOAC. DOAC users were 6percentage points (95%CI -4-16) more likely to improve> 5 points on Convenience; 22 pp. (95%CI 1-43) in patients who scored< 95/100 at baseline. The probability to meaningfully improve on PACT-Q Satisfaction was 12 pp. (95%CI 0-25) higher on DOAC. However, 5 (4.1%) and 4 (3.3%) DOAC users resumed VKA because of side-effects and patient preference. Switching from well-controlled VKA to DOAC for AF leads to a higher probability of improved PACT-Q convenience and satisfaction, but also to a higher risk of side-effects. Arguably only patients who are not satisfied with VKA should switch, because they have more to gain by switching.