Oral anticoagulation therapy and subsequent risk of venous thromboembolism in atrial fibrillation patients.
Oral anticoagulation therapy and subsequent risk of venous thromboembolism in atrial fibrillation patients.
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DOI：
10.1080/03007995.2018.1541445
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发表时间：
2019-05
影响因子：
2.3
通讯作者：
Alonso A
中科院分区：
文献类型：
--
作者：
Lutsey PL;Norby FL;Zakai NA;MacLehose RF;Chen LY;Shah S;Datta YH;Alonso A
口服抗凝药（OAC）用于房颤患者预防心源性栓塞并发症可能还有预防静脉血栓栓塞（VTE）的额外益处。我们在接受抗凝治疗的房颤患者中评估了OAC的类型是否与后续的VTE风险相关。
通过MarketScan管理索赔数据库确定了2010年至2015年9月期间开具OAC的非瓣膜性房颤患者。OAC包括华法林和直接口服抗凝药（DOAC：达比加群、利伐沙班和阿哌沙班）。VTE事件依据国际疾病分类第九版临床修订本（ICD - 9 - CM）编码定义。患者根据年龄、性别、CHA₂DS₂ - VASc评分和高维倾向评分进行匹配。最终分析纳入了117,912例房颤患者。
在平均484天的随访期间，共发生1357例VTE事件。在多变量调整且倾向评分匹配的考克斯模型中，与新使用华法林的患者相比，新使用达比加群[风险比（95%置信区间）：0.55（0.47 - 0.66）]和阿哌沙班[0.51（0.39 - 0.68）]的患者发生VTE的风险较低，但新使用利伐沙班的患者风险相似[1.01（0.87 - 1.19）]。在直接口服抗凝药的头对头比较中，与使用利伐沙班相比，使用达比加群[0.48（0.36，0.64）]和阿哌沙班[0.61（0.47，0.78）]的患者VTE风险较低。在各患者亚组中，结果大致相似。
在这个基于大量临床实践的因预防卒中及全身性栓塞而开具OAC的房颤患者群体中，开具阿哌沙班和达比加群的患者后续VTE风险最低，而开具华法林和利伐沙班的患者风险相似。在开具OAC的房颤患者中，降低VTE风险可能是阿哌沙班和达比加群的一项额外益处，这超出了随机临床试验中所观察到的出血风险降低的益处。
Oral anticoagulation (OAC) prescribed to AF patients for the prevention of cardioembolic complications likely has the added benefit of preventing venous thromboembolism (VTE). We evaluated, among AF patients who are anticoagulated, whether type of OAC was associated with subsequent VTE risk. Non-valvular AF patients prescribed OACs between 2010 and September 2015 were identified via the MarketScan administrative claims databases. OACs included warfarin and direct OACs (DOACs: dabigatran, rivaroxaban and apixaban). Incident VTE was defined by ICD-9-CM codes. Patients were matched on age, sex, CHA2DS2-VASc and high-dimensional propensity scores. The final analysis included 117,912 AF patients. 1,357 VTE events accrued over a mean follow-up of 484 days. In multivariable-adjusted, propensity score-matched Cox models, relative to new users of warfarin, risk of incident VTE was lower among new users of dabigatran [hazard ratio (95% confidence interval): 0.55 (0.47–0.66)] and apixaban [0.51 (0.39–0.68)], but similar among new users of rivaroxaban [1.01 (0.87–1.19)]. In head-to-head DOAC comparisons, VTE risk was lower among users of dabigatran [0.48 (0.36, 0.64)] and apixaban [0.61 (0.47, 0.78)], versus rivaroxaban. Findings were mostly similar across patient subgroups. In this large practice-based population of AF patients prescribed OACs for primary prevention of stroke and systemic embolization, subsequent risk of VTE was lowest among those prescribed apixaban and dabigatran, while risk was similar with prescriptions for warfarin and rivaroxaban. Among AF patients prescribed OACs, lowering risk of VTE may be an additional benefit of apixaban and dabigatran, beyond the reduced bleeding risk observed in randomized clinical trials.
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影响因子：
3
作者：
Fang MC;Fan D;Sung SH;Witt DM;Schmelzer JR;Steinhubl SR;Yale SH;Go AS
通讯作者：
Go AS
影响因子：
9.6
作者：
Falck-Ytter, Yngve;Francis, Charles W.;Colwell, Clifford W., Jr.
通讯作者：
Colwell, Clifford W., Jr.
影响因子：
5.9
作者：
Bell, Elizabeth J.;Lutsey, Pamela L.;Folsom, Aaron R.
通讯作者：
Folsom, Aaron R.
影响因子：
5.4
作者：
Hernan, Miguel A.;Alonso, Alvaro;Robins, James M.
通讯作者：
Robins, James M.
影响因子：
158.5
作者：
Agnelli, Giancarlo;Buller, Harry R.;Weitz, Jeffrey I.
通讯作者：
Weitz, Jeffrey I.