Factors Driving Anticoagulant Selection in Patients With Atrial Fibrillation in the United States
Factors Driving Anticoagulant Selection in Patients With Atrial Fibrillation in the United States
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DOI：
10.1016/j.amjcard.2015.01.539
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发表时间：
2015-04-15
影响因子：
2.8
通讯作者：
Fang, Gang
中科院分区：
文献类型：
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作者：
Lauffenburger, Julie C.;Farley, Joel F.;Fang, Gang
随着新型口服抗凝剂（NOAC）的引入，在现实世界中，驱动房颤（AF）抗凝剂选择的因素尚不清楚。目的是检查中风风险（治疗益处）、出血风险（治疗危害）或处方福利覆盖范围的预测是否以及在多大程度上驱动了利用。我们从美国大型商业和医疗保险补充索赔数据库中提取了一组 2010 年 10 月至 2012 年 12 月期间开始抗凝治疗的非瓣膜性 AF 患者。多变量回归研究了缺血性卒中 (CHA(2)DS(2)-VASc) 与出血（心房颤动的抗凝和危险因素 [ATRIA]）风险评分和华法林和新型口服抗凝剂 (NOAC) 选择的获益慷慨程度（患者支付的费用相对于总费用的比例）之间的关联，以及达比加群和利伐沙班之间的关联。使用 C 统计量和部分卡方统计量来评估所解释的变异。在 70,498 名开始抗凝治疗的患者中，分别有 29.9% 和 7.9% 使用达比加群和利伐沙班。与华法林相比，具有高缺血性卒中风险（CHA(2)DS(2)-VASc >= 2；调整后相对风险[aRR] 0.75，95%置信区间[CI] 0.72至0.77）和高出血风险（ATRIA >= 5；aRR 0.66，95% CI 0.64至0.69）的患者接受NOAC的可能性较小，但接受良好治疗的患者接受NOAC的可能性更大。福利的慷慨（
With the introduction of novel oral anticoagulants (NOACs), the factors driving anticoagulant selection in atrial fibrillation (AF) in real-world practice are unclear. The goal was to examine whether and to what extent utilization has been driven by predictions of stroke risk (treatment benefit), bleeding risk (treatment harm), or prescription benefits' coverage. We extracted a cohort of patients with nonvalvular AF initiating anticoagulation from October 2010 to December 2012 from a large US database of commercial and Medicare supplement claims. Multivariable regression examined associations between ischemic stroke (CHA(2)DS(2)-VASc) and bleeding (Anticoagulation and Risk Factors in Atrial Fibrillation [ATRIA]) risk scores and benefits' generosity (proportion of costs covered by patients relative to total) with warfarin and novel oral anticoagulant (NOAC) selection and also between dabigatran and rivaroxaban. C-statistics and partial chi-square statistics were used to assess the variation explained. Of 70,498 patients initiating anticoagulation, 29.9% and 7.9% used dabigatran and rivaroxaban, respectively. Compared with warfarin, patients were less likely to receive an NOAC with high ischemic stroke risk (CHA(2)DS(2)-VASc >= 2; adjusted relative risk [aRR] 0.75, 95% confidence interval [CI] 0.72 to 0.77) and high bleeding risk (ATRIA >= 5; aRR 0.66, 95% CI 0.64 to 0.69) but more likely with good benefits' generosity (