Effectiveness and Safety of Apixaban, Low-Molecular-Weight Heparin, and Warfarin among Venous Thromboembolism Patients with Active Cancer: A U.S. Claims Data Analysis.
Effectiveness and Safety of Apixaban, Low-Molecular-Weight Heparin, and Warfarin among Venous Thromboembolism Patients with Active Cancer: A U.S. Claims Data Analysis.
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DOI：
10.1055/s-0040-1718728
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发表时间：
2021-03
影响因子：
6.7
通讯作者：
Luo X
中科院分区：
文献类型：
--
作者：
Cohen A;Keshishian A;Lee T;Wygant G;Rosenblatt L;Hlavacek P;Mardekian J;Wiederkehr D;Sah J;Luo X
背景本研究主要评估静脉血栓栓塞（VTE）和活动性癌症患者使用阿哌沙班、低分子量肝素（LMWH）或华法林的复发性静脉血栓栓塞（VTE）和大出血（MB）风险，并提供索赔数据。 方法使用4个美国商业保险索赔数据库，以确定在首次VTE事件发生后30天内开始使用阿哌沙班、LMWH或华法林的VTE和活动性癌症患者。 使用稳定的逆概率治疗加权（IPTW）来平衡治疗队列。使用考克斯比例风险模型评价复发性VTE和MB的风险。 结果3，393例阿哌沙班、6，108例LMWH和4，585例华法林患者符合所有合格标准。 IPTW后，所有患者特征平衡。当随访在6个月时删失时，阿哌沙班患者的复发性VTE（风险比[HR]：0.61; 95%置信区间[CI]：0.47 - 0.81）和MB（HR：0.63; 95% CI：0.47 - 0.86）风险低于LMWH。与华法林相比，阿哌沙班患者的复发性VTE风险较低（HR：0.68; 95% CI：0.52 - 0.90），MB风险相似（HR：0.73; 95% CI：0.53 - 1.00）。与LMWH相比，华法林患者的复发性VTE（HR：0.91; 95% CI：0.72 - 1.15）和MB（HR：0.87; 95% CI：0.68 - 1.12）风险相似。整个随访期间的趋势相似;然而，阿哌沙班患者的MB风险低于华法林患者。 结论与LMWH患者相比，开始阿哌沙班治疗的VTE和活动性癌症患者复发VTE和MB的风险较低。 阿哌沙班患者的VTE复发风险也低于华法林患者。
Background This study primarily evaluates the risk of recurrent venous thromboembolism (VTE) and major bleeding (MB) among patients with VTE and active cancer prescribed apixaban, low-molecular-weight heparin (LMWH), or warfarin, with claims data. Methods Four U.S. commercial insurance claims databases were used to identify patients with VTE and active cancer who initiated apixaban, LMWH, or warfarin within 30 days following the first VTE event. Stabilized inverse-probability treatment weighting (IPTW) was used to balance treatment cohorts. Cox proportional hazard models were used to evaluate risk of recurrent VTE and MB. Results All eligibility criteria were fulfilled by 3,393 apixaban, 6,108 LMWH, and 4,585 warfarin patients. After IPTW, all patient characteristics were balanced. When the follow-up was censored at 6 months, apixaban patients had a lower risk of recurrent VTE (hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.47–0.81) and MB (HR: 0.63; 95% CI: 0.47–0.86) versus LMWH. Apixaban patients had a lower risk of recurrent VTE (HR: 0.68; 95% CI: 0.52–0.90) and similar risk of MB (HR: 0.73; 95% CI: 0.53–1.00) versus warfarin. Warfarin patients had a similar risk of recurrent VTE (HR: 0.91; 95% CI: 0.72–1.15) and MB (HR: 0.87; 95% CI: 0.68–1.12) versus LMWH. The trends were similar for the entire follow-up; however, apixaban patients had a lower risk of MB versus warfarin patients. Conclusion Patients with VTE and active cancer who initiated apixaban had a lower risk of recurrent VTE and MB compared with LMWH patients. Apixaban patients also had a lower risk of recurrent VTE compared with warfarin patients.
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影响因子：
2
作者：
Austin PC
通讯作者：
Austin PC
影响因子：
45.3
作者：
Key, Nigel S.;Khorana, Alok A.;Falanga, Anna
通讯作者：
Falanga, Anna
影响因子：
9.6
作者：
Kearon, Clive;Akl, Elie A.;Moores, Lisa
通讯作者：
Moores, Lisa
影响因子：
7.5
作者：
Gussoni, Gualberto;Frasson, Stefania;Monreal, Manuel
通讯作者：
Monreal, Manuel
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