National Trends in Ambulatory Oral Anticoagulant Use.
National Trends in Ambulatory Oral Anticoagulant Use.
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DOI：
10.1016/j.amjmed.2015.05.044
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Goldberger ZD
中科院分区：
文献类型：
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作者：
Barnes GD;Lucas E;Alexander GC;Goldberger ZD
四种直接口服抗凝剂(DOAC)已被推向市场，用于治疗非瓣膜性房颤和静脉血栓栓塞症。许多因素，包括大量积极的试验结果、新出现的安全问题、营销和推广，可能会影响供应商对DOAC的采用。然而，与华法林相比，人们对它们的动态利用以及它们在房颤治疗下的减少程度知之甚少。我们使用IMS健康国家疾病和治疗指数，这是对门诊就诊的全国代表性审计，以估计2009至2014年间华法林和DOAC的使用情况。总体而言，使用抗凝剂的就诊人次从2.05(95%可信区间1.82-2.27)增加到2.83百万人次(95%可信区间2.49-3.17万)(P<；0.001)。其中，DOAC的使用自2010年推出以来，2014年已增长至421万次(95%可信区间为363万-479万；占总治疗次数的38.2%)。2014年，所有口服抗凝剂在房颤治疗中的使用量从0.88M(95%CI 0.74M-1.02M)增加到1.72M(95%CI 1.47M-1.97M；P<；0.001)，DOAC和华法林的使用量相似。在2009年至2014年期间，使用抗凝剂的房颤就诊率从51.9%(95%可信区间50.4%~53.8%)上升至66.9%(95%可信区间65.0%~69.3%)(p<；0.001)。2014年，利伐沙班是治疗房颤最常用的DOAC(47.9%)，其次是apixaban(26.5%)和dabigatran(25.5%)。DOAC已迅速被采用，与华法林的使用相匹配，并与心房颤动患者更多地使用口服抗凝有关。
Four direct oral anticoagulants (DOACs) have been brought to market for the treatment of nonvalvular atrial fibrillation and venous thromboembolism. Many forces, including numerous positive trial results, emerging safety concerns, marketing and promotion may shape DOAC adoption by providers. However, relatively little is known regarding their ambulatory utilization compared with warfarin, as well as the degree to which they have decreased undertreatment of atrial fibrillation. We used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of outpatient office visits, to estimate the use of warfarin and DOACs between 2009 and 2014. Overall, visits with anticoagulation use increased from 2.05 (95% CI 1.82-2.27) to 2.83 (95% CI 2.49-3.17) million (M) quarterly visits (p<0.001). Of these, DOAC use has grown to 4.21M (95% CI 3.63M-4.79M; 38.2% of total) treatment visits in 2014 since their introduction in 2010. Use of all oral anticoagulants in treatment visits for atrial fibrillation has increased from 0.88M (95% CI 0.74M-1.02M) to 1.72M (95% CI 1.47M -1.97M; p<0.001), with similar DOAC and warfarin use in 2014. Atrial Fibrillation visits with anticoagulant use increased from 51.9% (95% CI 50.4%-53.8%) to 66.9% (95% CI 65.0%-69.3%) between 2009 and 2014 (p<0.001). In 2014, rivaroxaban was the most commonly prescribed DOAC for atrial fibrillation (47.9% of office visits), followed by apixaban (26.5%) and dabigatran (25.5%). DOACs have been rapidly adopted, matching the use of warfarin, and are associated with increased use of oral anticoagulation for patients with atrial fibrillation.